Reaching for the gold standard of lung cancer screening

by Stephen Riddle

Time is a precious resource in oncology. Detecting patients with cancer as early as possible gives clinicians the best chance to formulate a successful treatment response. Any delay in diagnosis or treatment can severely impact the options available to patients and healthcare professionals.

As early intervention in lung cancer means patients have the best chance of better outcomes,1 it’s important that patients are aware of, and have access to, the highest standard of care available. Today’s optimal standard of care involves detecting cancer cells as early as possible, getting patients onto the right treatment for them, and managing their care with efficient and effective care pathways.2

In lung cancer, early detection is particularly important, as symptoms typically do not appear until the disease has already reached an advanced stage of development. This is exacerbated by a stigma around smoking,3 fatalistic perceptions of cancer,4 and a general anxiety of testing and screening.5

Therefore, it is essential to adopt a proactive approach to inform patients about local lung cancer screening programmes, and the benefits early diagnosis offers.

One of the biggest challenges clinicians face is that patients may not be aware of the lung cancer screening programmes offered. As part of efforts to increase uptake of screening programmes, purpose-driven partnerships between the NHS and the pharma industry have emerged as an innovative solution to raise patient awareness.

“There is not a single expertise that exists with one organisation that is able to solve the problem of cancer,” explains Arun Krishna, UK country head in Oncology for AstraZeneca. “It exists in multiple areas across multiple organisations. The question is how we bring them all together to be able to solve a common cause.”

In 2021, a pilot communications programme from AstraZeneca UK and the NHS was launched in four locations across England. It aimed to diagnose lung conditions, such as lung cancer, at an earlier stage. As part of the NHS England Targeted Lung Health Checks (TLHCs) initiative, AstraZeneca and the NHS collaborated on the patient disease awareness campaign that prompted eligible patients to rethink perceptions of lung cancer.

Changing perceptions of lung cancer treatment
In lung cancer, the path to treatment begins with an initial diagnosis. TLHCs are designed to catch lung cancer during the early stages of development in asymptomatic patients with a high risk of developing the disease. At present, this service is offered to current and former smokers aged between 55 and 74.6

The overall lung health check process is relatively straightforward. Once an eligible patient registers their interest in the service, a specially trained respiratory nurse will conduct an initial phone assessment. If the patient is deemed at high risk of developing lung cancer, they are offered a low dose CT scan to further investigate their lung health.

Traditionally, eligible participants are sent a letter to inform them of nearby programmes, followed by a courtesy phone call. However, this approach had a limited impact on the majority of patients.

“Because it was a new service, people were concerned that it was a scam or just another flyer to put in the bin,” explains Jane Derbyshire, lung project lead for RM Partners West London Cancer Alliance. “The fact is, we’re working with people who smoke or used to smoke, and who may want to avoid thinking about cancer and what it means.”

Combined with the growing stigma around smoking, this lack of awareness and understanding of how early diagnosis programmes function served to reinforce commonly held perceptions that cancer could not be treated.

Debunking such ingrained ideas is no easy task for any one organisation. For Krishna, achieving the best standard of care requires collaboration. It requires a multi-pronged approach to improve the reality of lung cancer treatment including screening and patient identification, utilising innovative medicines and implementing optimised cancer pathways.

“We’ve seen a lot of partnerships in the cardiovascular space and respiratory area, which have led to benefits that really impact patients. We can learn from these efforts and translate that into cancer.” he explains. “The stigma around cancer needs to be evolved now to say: ‘yes, cancer can be debilitating. But if it’s caught and treated early, your chances are better.”

Check Your Lungs: an innovative initiative
To help reframe public perceptions of lung cancer and draw attention to the availability of early screening programmes, AstraZeneca and RM Partners West London Cancer Alliance joined forces. Together, they developed a bold new awareness campaign to help drive awareness of the need for patients at risk of lung cancer to get screened.

“We did extensive market research in many locations to gather insights into the current situation, including what patients like to see and what kind of campaign would actually help to activate them. We then worked in partnership to co-create and develop the campaign. And then finally, we worked with the community to roll it out,” says Krishna.

Collaboration was a central element of the design of the campaign. Through the partnership, each contributor provided an important skill or resource that helped to shape the end result.

With limited NHS budgets and resources in high demand across the UK, entering appropriate partnerships with the pharmaceutical industry can provide much-needed support to aid in the pursuit of a shared goal. Such partnerships are mutually beneficial for all involved parties as pharma companies have a wealth of data, insight, and connections at their disposal, resources that can play a central role in enabling early diagnosis for the NHS and patients.

“Given our clinical expertise, the NHS is well placed to provide the lung check programme itself and expertise as to the key issues,” explains Dr Ley Chan, Respiratory Physician & Clinical Fellow at Royal Brompton Hospital. “AstraZeneca brought us a completely different wide set of skills, such as the ability to design a media campaign and having advertising expertise as well as the outreach capability.”

Using striking optical illusion imagery, the Check Your Lungs campaign aimed to spark awareness that perception is not always equal to reality. Just as a person’s eyes may trick them into believing that a static image is moving, a lack of symptoms may similarly warp their perception of lung cancer.

The eye-catching campaign materials were placed in strategic locations across the three participating boroughs in west London, bringing the topic out of the home or clinical setting and firmly into the public setting. Targeted adverts were also seen on Facebook and Google, further expanding the reach of the information as social media users shared the posts with friends and family members.

“The first month was phenomenal,” says Derbyshire. “Everything went up. Visits to our lung health checks website, phone calls to the lung health checks team for appointments, and the number of scans all increased, and we’ve mostly sustained that since.”

Increased interest in the services behind the campaign showed how effective innovative marketing can be in motivating patients to engage with an uncomfortable subject. This action extended beyond the initial phone consultation, as clinicians also saw an increase in the number of patients referred for CT scans after the campaign was unveiled.

“There was a greater conversion rate during the campaign,” says Chan. “The number of patients who ended up having a CT scan went from about 30% to 40%,7 which we simply could not have achieved without the input from AstraZeneca and this collaboration.”

Success through campaign scalability
From an early stage, scalability was a core focus for all those involved in the development of the campaign. The goal set out by the NHSE Long Term Plan is ambitions: to have three quarters of cancers diagnosed at an early stage by 2028.8 If the early lung screening programme is to achieve this, it is vital to identify how campaigns can be developed to further improve access to more patients across the nation.

Based upon the success of the initial partnership, proactively seeking out new opportunities for collaboration is a focal point for Derbyshire. “We’ve learned that partnerships work and that impactful messages and imagery are really important,” she explains. “We have seen what can be achieved through working collaboratively and are looking for ways we can build upon these successes working both with AstraZeneca and other partners.”

Building upon AstraZeneca’s experience working during the COVID-19 pandemic and the company’s work in boosting the reach of vital health programmes, Krishna emphasises the need for existing and future collaborations with like-minded organisations across the UK to achieve a health revolution both inside and outside of cancer care.

“We need to work in partnerships to optimise the total number of patients coming into targeted lung health checks,” agrees Krishna. “But there are also many areas within the cancer space that require screening and intervention, for example, head and neck cancers and bowel cancers. So, there’s definite scalability in that space.”

Forewarned is forearmed
Reaching for the pinnacle ‘gold standard’ of cancer screening is a complicated task. As Krishna details, it is a task that cannot be achieved by siloed pharma and healthcare providers working in isolation. It is through partnerships and collaboration that the industry can connect at-risk patients with the appropriate treatment.

The pharma industry has an important role to play in the future of cancer treatment and research. As illustrated through the collaborative Check Your Lungs campaign, AstraZeneca and the NHS have a shared focus for the future, with both organisations working towards the same ambitions using NHS cancer strategies as a blueprint for delivering vital cancer care services in the UK.

Great strides have been made in early lung cancer treatment but putting these innovations to use requires patients to be aware that there are options available for them. Importantly, sharing information about early interventions can help to relieve anxiety over the dreaded ‘C’ word.

“The paradigm of science has fundamentally evolved,” concludes Krishna. “We’re now able to screen and make a diagnosis earlier. This means patients can have access to treatment earlier which can help improve chances of survival. But none of this can happen if patients are not screened early and arrive in a metastatic setting.”

This is a sponsored feature paid-for by AstraZeneca UK and is intended for a UK Healthcare Professional Audience only.

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August 2022

About the panel

Arun Krishna

Arun KrishnaArun Krishna, UK country head in Oncology, AstraZeneca was born in India, where he obtained a bachelor’s degree in engineering, before moving to the United States to complete a doctorate degree in biostatistics at North Carolina State University. Arun leads AstraZeneca’s efforts to redefine cancer care in the UK, which includes finding novel ways of detecting, treating and managing cancers. Arun previously worked as business unit director and prior to that he has had numerous leadership positions that spans clinical development, new product strategy, market access and policy across US and the UK.

Dr Ley Chan

Dr Ley ChanDr Ley Chan, clinical research fellow for Targeted Lung Health Check programme at RM Partners. Dr Ley Chan is a senior respiratory registrar training in North West London who joined the Targeted Lung Health Check programme in April 2021. She is based at the Royal Brompton Hospital and her role involves implementing the programme, protocol development and execution. Dr Chan is a PhD student at the National Heart and Lung Institute. Her current research interests are in the development of methods and tools for early lung cancer diagnosis.

Jane Derbyshire

Jane DerbyshireJane Derbyshire, project manager, Targeted Lung Health Check Programme at RM Partners has worked at RM Partners, the West London Cancer Alliance, since 2017 implementing the lung health checks programme working closely with primary care and the Royal Brompton Hospital team. Jane has worked in the NHS for over 14 years in both public health promotion and children’s services commissioning and as part of the policy team at Macmillan Cancer Support.

About AstraZeneca UK

AstraZeneca aims to lead a revolution in oncology to redefine cancer care in the UK. With our clinical strategy, we turn science into medicine, searching for cures for cancer in every form. Everything we do begins with science and centres around the patient experience. The UK sits at the heart of our global oncology mission with over 8,000 colleagues all across the country. Our new global R&D centre in Cambridge is one of the most exciting bioscience hotspots in the world. By combining our expertise with that of the wider UK life sciences community we are tackling some of the hardest to reach cancers with our strong portfolio and pipeline. Our ambition is to eliminate cancer as a cause of death. Our people are the power and passion behind our progress. We foster an inclusive people culture where diversity drives innovation.

Find out more: www.astrazeneca.co.uk/about-us.html

References
1. WHO. Promoting Cancer Early Diagnosis. Cited at: https://www.who.int/activities/promoting-cancer-early-diagnosis [Last accessed: September 2022]
2. NHS England. Implementing Timed Lung Cancer Diagnosis. Cited at: https://www.england.nhs.uk/wp-content/uploads/2018/04/implementing-timed-lung-cancer-diagnostic-pathway.pdf [Last accessed: September 2022]
3. NHS England. We must stop lung disease prejudices. Cited at: https://www.england.nhs.uk/blog/we-must-stop-lung-disease-prejudices [Last accessed: September 2022
4. Lyratzopoulos G et al. The association between fatalistic beliefs and late stage at diagnosis of lung and colorectal cancer. Cancer Epidemiol Biomarkers Prev. 2015; 24(4): 720–726.
5. Cancer Research UK. What is cancer screening? Cited at: https://www.cancerresearchuk.org/about-cancer/cancer-symptoms/spot-cancer-early/screening/what-is-cancer-screening [Last accessed: September 2022]
6. NHS England. Early diagnosis. Cited at: https://www.england.nhs.uk/cancer/early-diagnosis [Last accessed: September 2022]
7. Date on file. June 2022.
8. NHS England. NHS Long Term Plan. Cited at: https://www.longtermplan.nhs.uk [Last accessed: September 2022]

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