Lung cancer screening for survivors of Hodgkin lymphoma

Abstract

Hodgkin lymphoma survivors (HLS) are at excess risk of lung cancer. There is a rationale for developing a targeted LCS programme for HL survivors, however there are gaps in the literature pertaining to its' feasibility, specifically: the views of HLS; the motivators and barriers to participation; how to inform and invite HLS to screening; and the likely uptake rate. This programme of research aimed to address these gaps in the literature. In the first study, the views of HLS on LCS were sought. Key findings were a lack of awareness of lung cancer risk, and high levels of willingness to undergo LCS motivated by positive beliefs around cancer early detection. The second study surveyed HLS to identify the psycho-social factors associated with willingness to undergo LCS. Being male, living in a less deprived area and lower levels of self-efficacy were associated with hesitancy to undergo LCS. The third study used mixed methods to test a novel LCS decision aid (DA) among HLS and practitioners. The DA improved knowledge and reduced decisional conflict among HLS. The study identified ways in which the DA prototype could be improved prior to use in an LCS pilot. The fourth study was a pilot of LCS for HLS which utilised the DA. The overall response rate was 58%. Decision-making outcomes supported the use of the DA. The prevalence of screen-detected lung cancer screened was 2%. Rates of clinically significant incidental findings were low, but there were high rates of coronary artery calcification. The fifth study explored drivers of LCS uptake among HLS invited to the pilot. Drivers of uptake included the belief that early detection of lung cancer is associated with better outcomes, desire for reassurance and knowledge and altruism. Concerns around radiation-induced cancers drove the decision to decline screening. This body of work suggests that a larger study of LCS would be acceptable and feasible and supports the future use of the novel DA.

Date of Award	1 Aug 2023
Original language	English
Awarding Institution	The University of Manchester
Supervisor	John Radford (Supervisor), Christopher Arden Armitage (Supervisor), Kim Linton (Supervisor) & Philip Crosbie (Supervisor)