title: Immediate chest X-ray for patients at risk of lung cancer presenting in primary care: randomised controlled feasibility trial.
abstract: Achieving earlier stage diagnosis is one option for improving lung cancer outcomes in the United Kingdom. Patients with lung cancer typically present with symptoms to general practitioners several times before referral or investigation.
  
  
  
  We undertook a mixed methods feasibility individually randomised controlled trial (the ELCID trial) to assess the feasibility and inform the design of a definitive, fully powered, UK-wide, Phase III trial of lowering the threshold for urgent investigation of suspected lung cancer. Patients over 60, with a smoking history, presenting with new chest symptoms to primary care, were eligible to be randomised to intervention (urgent chest X-ray) or usual care.
  
  
  
  The trial design and materials were acceptable to GPs and patients. We randomised 255 patients from 22 practices, although the proportion of eligible patients who participated was lower than expected. Survey responses (89%), and the fidelity of the intervention (82% patients X-rayed within 3 weeks) were good. There was slightly higher anxiety and depression in the control arm in participants aged >75. Three patients (1.2%) were diagnosed with lung cancer.
  
  
  
  We have demonstrated the feasibility of individually randomising patients at higher risk of lung cancer, to a trial offering urgent investigation or usual care.
authors.affiliation: Leeds Institute for Health Sciences, University of Leeds, Leeds LS2 9NL, UK.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Neal
authors.affiliation: Patient representative, Cardiff, UK.
authors.forename: Allan
authors.initials: A
authors.lastname: Barham
authors.affiliation: MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.
authors.forename: Emily
authors.initials: E
authors.lastname: Bongard
authors.affiliation: Centre for Health Economics and Medicines Evaluation, Bangor University, Gwynedd, UK.
authors.forename: Rhiannon Tudor
authors.initials: RT
authors.lastname: Edwards
authors.affiliation: Patient representative, Cardiff, UK.
authors.forename: Jim
authors.initials: J
authors.lastname: Fitzgibbon
authors.affiliation: Southampton Clinical Trials Unit, University of Southampton, Southampton, UK.
authors.forename: Gareth
authors.initials: G
authors.lastname: Griffiths
authors.affiliation: University of Exeter Medical School, Exeter, UK.
authors.forename: Willie
authors.initials: W
authors.lastname: Hamilton
authors.affiliation: Centre for Trials Research, Cardiff University, Cardiff, UK.
authors.forename: Kerenza
authors.initials: K
authors.lastname: Hood
authors.affiliation: Marie Curie Palliative Care Research Centre School of Medicine, Cardiff University, Cardiff, UK.
authors.forename: Annmarie
authors.initials: A
authors.lastname: Nelson
authors.affiliation: Betsi Cadwaladr University Health Board, Wrexham Maelor Hospital, Wrexham, UK.
authors.forename: David
authors.initials: D
authors.lastname: Parker
authors.affiliation: Wales Cancer Trials Unit, Centre for Trials Research, Cardiff University, Cardiff, UK.
authors.forename: Cath
authors.initials: C
authors.lastname: Porter
authors.affiliation: Marie Curie Palliative Care Research Centre School of Medicine, Cardiff University, Cardiff, UK.
authors.forename: Hayley
authors.initials: H
authors.lastname: Prout
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: Kirsty
authors.initials: K
authors.lastname: Roberts
authors.affiliation: Doncaster Royal Infirmary, Doncaster and Bassetlaw NHS Foundation Trust, Doncaster, UK.
authors.forename: Trevor
authors.initials: T
authors.lastname: Rogers
authors.affiliation: South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Cardiff, UK.
authors.forename: Emma
authors.initials: E
authors.lastname: Thomas-Jones
authors.affiliation: Sheffield University, Sheffield, UK.
authors.forename: Angela
authors.initials: A
authors.lastname: Tod
authors.affiliation: Centre for Health Economics and Medicines Evaluation, Bangor University, Gwynedd, UK.
authors.forename: Seow Tien
authors.initials: ST
authors.lastname: Yeo
authors.affiliation: Wales Cancer Trials Unit, Centre for Trials Research, Cardiff University, Cardiff, UK.
authors.forename: Chris N
authors.initials: CN
authors.lastname: Hurt
mesh_terms: D000368:Aged; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000706:statistics & numerical data*; D013902:Radiography, Thoracic; D012307:Risk Factors; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology; D014965:X-Rays