title: A feasibility study examining the effect on lung cancer diagnosis of offering a chest X-ray to higher-risk patients with chest symptoms: protocol for a randomized controlled trial.
abstract: BACKGROUND
  In order to improve lung cancer survival in the UK, a greater proportion of resectable cancers must be diagnosed. It is likely that resectability rates would be increased by more timely diagnosis. Aside from screening, the only way of achieving this is to reduce the time to diagnosis in symptomatic cancers. Currently, lung cancers are mainly diagnosed by general practitioners (GPs) using the National Institute for Health and Clinical Excellence (NICE) guidelines for urgent referral for chest X-ray, which recommend urgent imaging or referral for patients who have one of a number of chest symptoms for more than 3 weeks. We are proposing to expand this recommendation to include one of a number of chest symptoms of any duration in higher-risk patients.
  
  
  METHODS
  We intend to conduct a trial of imaging in these higher-risk patients and compare it with NICE guidelines to see if imaging improves stage at diagnosis and resection rates. This trial would have to be large (and consequently resource-intensive) because most of these patients will not have lung cancer, making optimal design crucial. We are therefore conducting a pilot trial that will ascertain the feasibility of running a full trial and provide key information that will be required in order to design the full trial.
  
  
  CONCLUSIONS
  This trial will assess the feasibility and inform the design of a large, UK-wide, clinical trial of a change to the NICE guidelines for urgent referral for chest X-ray for suspected lung cancer. It utilizes a combination of workshop, health economic, quality of life, qualitative, and quantitative methods in order to fully assess feasibility.
  
  
  BACKGROUND
  Clinicaltrials.gov NCT01344005.
authors.affiliation: Wales Cancer Trials Unit, School of Medicine, Cardiff University, Cardiff, UK. hurtcn@cardiff.ac.uk.
authors.forename: Christopher N
authors.initials: CN
authors.lastname: Hurt
authors.forename: Kirsty
authors.initials: K
authors.lastname: Roberts
authors.forename: Trevor K
authors.initials: TK
authors.lastname: Rogers
authors.forename: Gareth O
authors.initials: GO
authors.lastname: Griffiths
authors.forename: Kerry
authors.initials: K
authors.lastname: Hood
authors.forename: Hayley
authors.initials: H
authors.lastname: Prout
authors.forename: Annmarie
authors.initials: A
authors.lastname: Nelson
authors.forename: Jim
authors.initials: J
authors.lastname: Fitzgibbon
authors.forename: Allan
authors.initials: A
authors.lastname: Barham
authors.forename: Emma
authors.initials: E
authors.lastname: Thomas-Jones
authors.forename: Rhiannon Tudor
authors.initials: RT
authors.lastname: Edwards
authors.forename: Seow Tien
authors.initials: ST
authors.lastname: Yeo
authors.forename: William
authors.initials: W
authors.lastname: Hamilton
authors.forename: Angela
authors.initials: A
authors.lastname: Tod
authors.forename: Richard D
authors.initials: RD
authors.lastname: Neal
mesh_terms: D002985:Clinical Protocols; D003625:Data Collection; D005240:Feasibility Studies; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging*; D017063:Outcome Assessment, Health Care; D013902:Radiography, Thoracic; D012107:Research Design; D012306:Risk; D018401:Sample Size