For General Practice teams
What is MEDLEY?
MEDLEY is a £1.2m feasibility study funded by National Institute for Health Research (NIHR), which commenced in August 2024 and will run for three years. It is taking place in Bath, Hull, Leeds, Manchester and Stoke. The purpose of the study is to understand whether common symptoms of lung cancer (cough, shortness of breath etc as outlined in NICE NG12 but not including haemoptysis) should be investigated with Low Dose CT (LDCT) instead of chest x-ray. More information about MEDLEY is available via NIHR.
Information for General Practice Teams
Why is MEDLEY important?
Lung cancer is our leading cause of cancer death and is a key driver of premature mortality and of health inequalities. However, the main investigation we use in general practice, chest x-ray, has a sensitivity of only around 80%, meaning it ‘misses’ around a fifth of lung cancers. CT is much more accurate, but the individual risk for patients with common symptoms is low, at around 1%. With fewer CT scanners and radiology staff than other countries it may not be feasible to use CT for all these patients. MEDLEY will generate understanding about the feasibility of using LDCT as a first line investigation and whether a risk stratification approach (age and smoking status) could be used to select patients for LDCT instead of chest x-ray. We are optimistic that MEDLEY will lead to improvements in how we diagnose lung cancer and hopefully improved survival for patients.
Which patients will participate in MEDLEY and how will they be recruited?
The study will start recruiting patients from March 2025 for one year, with a target of 5 patients, per site, per week. Patients will be identified for possible recruitment into MEDLEY within the participating hospital trusts – i.e. there is no need for GPs to deviate from their normal practice of requesting CXRs for people with respiratory symptoms. The MEDLEY team will review chest X-ray requests from primary care to identify people who fulfil the inclusion criteria (symptoms that fulfil the NICE criteria for urgent chest X-ray because of possible lung cancer) and contact them directly (mostly by phone). Patients who are recruited will have a LDCT as well as a chest x-ray.
How will MEDLEY affect General Practices in Bath, Hull, Leeds, Manchester and Stoke?
MEDLEY has been designed so that GPs do not have to do any work to recruit patients, and the study should have very minimal impact. However, there are a few things we would like general practices to be aware of.
A very small proportion of patients referred for chest x-ray will have a LDCT performed as well as the chest x-ray requested (5/week for each of Bath, Hull, Leeds, Manchester and Stoke). The report the referring GPs will receive will be from the LDCT. This will not be in the usual way radiology reports are downloaded from the pathology system, but will be a standardised letter from a respiratory physician. This will outline the result of the scan and any actions that will be undertaken by the trust (e.g. follow up for nodules, or informing that urgent clinic appointment has been arranged for suspected cancer) or action suggested for GP (e.g. antibiotics for chest infection).
When patients are consented, it will be necessary to cancel the original GP request in order to make the new request for LDCT and MEDLEY study chest x-ray. Therefore, instead of a chest X-ray result, GPs will see a standard report which will state that the chest x-ray has been cancelled and that instead a letter will follow with the LDCT results.
If patients consent but then do not attend the study LDCT and chest x-ray and if they cannot be contacted by the study team to rearrange this, GPs will be informed of this and asked to consider rearranging the chest x-ray. Patients will also be contacted in writing and advised to re-present if they DNA both the MEDLEY chest x-ray and LDCT.
To find out more about MEDLEY
Email: [email protected]
Qualitative PIS for Interviews with invited GPs
We are inviting specific GPs to take part in interviews about the MEDLEY Study. You are not able to self-volunteer for these, you can only participate if directly invited by the MEDLEY qualitative researchers. If you have been invited, you can read the MEDLEY Patient Information Sheet (Qualitative Interviews) online or download a copy of it by clicking the following button.