SEARCH: Screening for early detection of second lung cancer after radiotherapy or chemotherapy for Hodgkin lymphoma
| ISRCTN | ISRCTN11668189 |
|---|---|
| DOI | https://doi.org/10.1186/ISRCTN11668189 |
| Sponsor | University of Manchester |
| Funders | SBRI Healthcare (NHS Cancer Programme Innovation Call), Manchester Biomedical Research Centre |
- Submission date
- 19/03/2026
- Registration date
- 30/03/2026
- Last edited
- 23/03/2026
- Recruitment status
- Recruiting
- Overall study status
- Ongoing
- Condition category
- Cancer
Plain English summary of protocol
Background and study aims
People who have been treated for Hodgkin lymphoma in the past have a higher risk of developing lung cancer later in life. This increased risk is mainly due to the radiotherapy and chemotherapy they received as part of their earlier cancer treatment. Lung cancer in this group is often found late, when it is harder to treat, because there is currently no dedicated screening programme for Hodgkin lymphoma survivors.
The SEARCH study aims to find out whether offering a low‑dose CT (LDCT) lung scan to higher‑risk survivors is practical, acceptable, and effective within the NHS. The study also aims to understand how best to identify people at higher risk, how people feel about being invited, and whether screening is equally accessible to everyone.
Who can participate?
Adults aged 45–74 years who:
previously had classical Hodgkin lymphoma,
completed their treatment at least 3 years ago,
have a history of smoking, and
are well enough to undergo lung cancer treatment if anything is found.
People must also be able to give informed consent.
What does the study involve?
Participation happens in several steps:
Invitation – Potential participants are identified through NHS records and invited by text message.
Initial telephone assessment – A screening nurse checks eligibility and explains the study.
Lung Health Check (LHC) – A short appointment (usually by phone or video) where the participant gives consent, answers health questions, and has their personal lung cancer risk calculated.
Low‑dose CT scan – People found to be at higher risk are offered an LDCT scan at an NHS hospital or mobile unit.
Results and follow‑up – Scan results are sent by post or phone using standard NHS processes.
Questionnaires – Participants complete short questionnaires at the start, 3 months, and 6 months to understand their experiences.
Some participants may also be invited to optional interviews or to give a saliva sample.
What are the possible benefits and risks of participating?
Possible benefits:
The LDCT scan may detect early signs of lung cancer, when treatment is more successful.
Participants may feel more informed about their lung health.
The study will help the NHS decide whether to offer screening widely to Hodgkin lymphoma survivors.
Possible risks or burdens:
Low‑dose CT scans involve a small amount of radiation.
The scan may detect findings that need further tests.
Some people may feel anxious before or after receiving results.
The study team minimises these risks through national safety procedures and clear information before, during and after the scan.
Where is the study run from?
The study is sponsored by The University of Manchester and delivered by NHS Lung Health Check teams across participating NHS Cancer Alliances in England.
When is the study starting and how long is it expected to run for?
The study is expected to begin in 2026 and run for approximately 2–3 years, including recruitment, scans, and follow‑up.
Who is funding the study?
The SEARCH study is funded by SBRI Healthcare (NHS Cancer Programme Innovation Call), with additional support from the NIHR Manchester Biomedical Research Centre.
Who is the main contact?
Professor Kim Linton
Chief Investigator, SEARCH Study
The University of Manchester
kim.linton@macnhester.ac.uk
Contact information
Public
Floor 6 Paterson Cancer Research Centre
Division of Cancer Sciences, The University of Manchester
Manchester
M20 4BX
United Kingdom
 ORCID ID |
0000-0003-3791-5290 |
|---|---|
| Phone | +44 7879779259 |
| tania.seale@manchester.ac.uk |
Scientific, Principal investigator
University of Manchester, Oxford Road M13
Manchester
M20 4BX
United Kingdom
| Phone | +44 7789206562 |
|---|---|
| kim.linton@macnhester.ac.uk |
Study information
| Primary study design | Interventional |
|---|---|
| Allocation | N/A: single arm study |
| Masking | Open (masking not used) |
| Control | Historical |
| Assignment | Single |
| Purpose | Screening |
| Scientific title | SEARCH: Screening for Early detection of second cancers After Radiotherapy and Chemotherapy for Hodgkin lymphoma . Implementing and evaluating lung cancer screening for high-risk Hodgkin lymphoma survivors within the NHS national lung cancer screening programme |
| Study acronym | SEARCH |
| Study objectives | The primary objective of the SEARCH study is to determine the proportion of lung cancers detected at an early stage (stage I–II) among high‑risk Hodgkin lymphoma (HL) survivors who meet PLCO‑HL risk criteria and undergo low‑dose CT (LDCT) screening within an adapted NHS Lung Cancer Screening Programme pathway. Secondary objectives are to: 1. Describe lung cancer screening outcomes, including cancer detection rate, stage distribution, histological subtype, false‑positive and false‑negative rates, incidental findings, and rates of curative‑intent treatment. 2. Compare the performance of lung cancer risk prediction models (PLCO‑HL, PLCOm2012 and LLPv2) in HL survivors, including measures of predictive accuracy and calibration. 3. Assess participation, feasibility and acceptability of the screening pathway at each stage (invitation, lung health check, LDCT, optional saliva sampling and patient‑reported outcomes). 4. Evaluate health inequalities in access, engagement and screening outcomes across demographic and socioeconomic groups. 5. Assess feasibility and operational delivery of implementing a PLCO‑HL risk‑adapted screening pathway across multiple NHS Cancer Alliances. 6. Undertake a health‑economic evaluation, including cost‑effectiveness, cost per early‑stage cancer detected, quality‑adjusted life years (QALYs) gained and return on investment. 7. Assess environmental impact, including carbon emissions associated with screening and emissions potentially avoided through earlier diagnosis. Exploratory objectives include evaluating enhancements to lung cancer risk prediction using additional clinical variables, assessing the performance of emerging risk models, and exploring the contribution of polygenic risk scores to lung cancer risk stratification in HL survivors. |
| Ethics approval(s) |
Not yet submitted |
| Health condition(s) or problem(s) studied | Lung cancer risk among survivors of classical Hodgkin lymphoma |
| Intervention | SEARCH is a multicentre, pragmatic, real‑world evaluation study integrating a risk‑adapted lung cancer screening pathway for high‑risk Hodgkin lymphoma (HL) survivors within the NHS Lung Cancer Screening Programme (LCSP). Eligible participants are identified through primary care searches and direct referrals across multiple NHS Cancer Alliances in England. Following an opt‑in invitation, participants attend a Lung Health Check (LHC) where informed consent is obtained and standardised data on demographics, clinical history and smoking behaviour are collected. Automated lung cancer risk assessment is performed using the investigational PLCO‑HL risk model alongside standard LCSP risk models (PLCOm2012 and LLPv2). Participants meeting predefined high‑risk thresholds are offered screening. Outcomes are evaluated using routinely collected NHS data and study‑specific assessments. Analyses are primarily descriptive, focusing on screening outcomes, feasibility, acceptability, health inequalities, and economic impact. Interventions The intervention is a risk‑based lung cancer screening pathway, comprising the following components: Risk assessment at Lung Health Check Participants undergo automated lung cancer risk assessment using PLCO‑HL in addition to standard LCSP risk models to identify those at elevated risk. Low‑dose CT (LDCT) screening Participants identified as high risk are offered a baseline LDCT scan delivered under standard NHS LCSP clinical governance. Image acquisition, reporting, nodule surveillance and referral pathways follow existing LCSP protocols. Clinical management of findings occurs entirely within routine NHS care. Follow‑up and outcome assessment Participants are followed for screening outcomes including lung cancer detection, stage at diagnosis, incidental findings and treatment outcomes, using routine NHS records and study data collection at defined follow‑up points. Patient‑reported outcomes (PROs) Participants complete questionnaires at baseline and follow‑up to assess acceptability, experience of screening, anxiety, quality of life and smoking behaviour. Optional saliva sampling (research component) Participants may optionally provide a saliva sample for genetic analysis. Samples are used for exploratory research purposes only, including genotyping and development of polygenic risk scores, and do not inform clinical decision‑making. Smoking cessation support All current smokers are offered brief smoking cessation advice and referral to NHS smoking cessation services in line with LCSP standards. The study does not involve investigational treatments. All imaging and clinical care are delivered through existing NHS pathways, with the intervention focused on risk‑based identification and targeted screening. |
| Intervention type | Device |
| Phase | Not Applicable |
| Drug / device / biological / vaccine name(s) | PLCO-HL |
| Primary outcome measure(s) |
|
| Key secondary outcome measure(s) | |
| Completion date | 01/06/2027 |
Eligibility
| Participant type(s) | |
|---|---|
| Age group | Mixed |
| Lower age limit | 45 Years |
| Upper age limit | 74 Years |
| Sex | All |
| Target sample size at registration | 4400 |
| Total final enrolment | 500 |
| Key inclusion criteria | 1. Previous classical Hodgkin lymphoma treated with chemotherapy ± radiotherapy; no relapse or HL treatment within the past 3 years 2. Age 45–74 years at identification. 3. Ever‑smoker (current or former), with smoking history verified (typically ≥100 lifetime cigarettes or equivalent). 4. Able to undergo LDCT, including ability to lie flat and weight ≤200 kg 5. Medically fit for potential curative‑intent lung cancer treatment (i.e., not severely frail and not on palliative care pathways). 6. Capacity to give informed consent 7. Individuals with a prior thoracic CT within 24 months may participate if imaging meets study standards (still complete LHC, risk assessment, ePRO, etc.) |
| Key exclusion criteria | 1. Never‑smokers: Individuals with no history of ever smoking 2. Lack of capacity to consent: Unable to provide informed consent at the time of enrolment 3. Incorrect lymphoma diagnosis: Any lymphoma other than classical Hodgkin lymphoma 4. History of lung cancer ≥24 months previously: Participants with a diagnosis of lung cancer occurring ≥24 months prior to identification 5. Unsuitable for LDCT scanning. Including: 5.1. Weight >200 kg 5.2. Unable to lie flat 5.3. Any physical, clinical, or technical contraindication preventing LDCT acquisition 6. Not medically fit for curative‑intent treatment. Including: 6.1. Severe frailty (eFI >0.36) 6.2. Registered on a palliative care register 6.3. Metastatic cancer with poor prognosis 6.4. Any comorbidity making curative treatment inappropriate 7. Self‑referrals from outside England: Individuals self‑referring from outside England are not eligible |
| Date of first enrolment | 01/05/2026 |
| Date of final enrolment | 01/05/2027 |
Locations
Countries of recruitment
- United Kingdom
- England
Study participating centres
Manchester
M13 9WL
England
Stoke-on -trent
ST4 6QG
England
Armthorpe Road
Doncaster
DN2 5LT
England
Derriford Road
Derriford
Plymouth
PL6 8DH
England
Tremona Road
Southampton
SO16 6YD
England
Cambridge
CB7 4EA
England
Lancaster Park Road
Harrogate
HG2 7SX
England
Fulham Road
Chelsea
London
SW3 6JJ
England
Results and Publications
| Individual participant data (IPD) Intention to share | No |
|---|
Editorial Notes
23/03/2026: Trial's existence confirmed by NHS England.
