Abstract
BackgroundLittle is known about 'within-patient delay', which is the time from first symptom of lung cancer to contacting primary care.AimPrimary outcomes were length of within-patient delay and the proportion of total delay it represents. Secondary outcomes were factors causing delay and survival.Design & settingA cohort study of newly diagnosed patients with lung cancer at two hospitals in Norfolk.MethodPatients completed questionnaires regarding onset of symptoms, whether they had delayed, and their reasons. GPs completed correlating questionnaires. Pathway times and other data were extracted from cancer registry and hospital records, and outcomes obtained prospectively. Factors causing delay were compared using ratios of geometric means.ResultsIn 379 patients, mean within-patient delay and pre-secondary care delay were 188.6 days and 241 days (61.4% and 78.5% of total delay, respectively). It was found that 38.8% of patients felt they had delayed. Patient-related causes of delay were denial (ratio of means [ROM] = 4.36; P = 0.002, 95% confidence interval [CI] = 1.71 to 11.1); anxiety (ROM = 3.36; P = 0.026; 95% CI = 1.16 to 9.76); non-recognition of symptoms (ROM = 2.80; P = 0.004; 95% CI = 1.41 to 5.59); and smoking (ROM = 1.76; P = 0.021; 95% CI = 1.09 to 2.86), respectively. These symptoms were associated with delay: finger swelling or discomfort (ROM = 2.72; P = 0.009, 95% CI = 1.29 to 5.74); cough (ROM = 2.53; P<0.001; 95% CI = 1.52 to 4.19); weight loss (ROM = 2.41; P<0.001; 95% CI = 1.49 to 3.88); weakness (ROM = 2.35; P = 0.001; 95% CI = 1.45 to 3.83); dyspnoea (ROM = 2.30; P = 0.001; 95% CI = 1.40 to 3.80); voice change (ROM = 1.90; P = 0.010; 95% CI = 1.17 to 3.10); and sputum (ROM = 1.66; P = 0.039; 95% CI = 1.03 to 2.67), respectively, also having more than five symptoms (compared with 1–3) (ROM = 3.69; P<0.001; 95% CI = 2.05 to 6.64). No overall relation between within-patient delay and survival was seen.ConclusionUsing smoking registers, awareness literature, and self-care manuals, primary care staff could liaise with people who have ever smoked regarding their symptoms to ensure early referral to secondary care.
Highlights
Lung cancer is the commonest cause of cancer death worldwide.[1]
Patient-related causes of delay were denial; anxiety (ROM = 3.36; P = 0.026; 95% CI = 1.16 to 9.76); non-recognition of symptoms (ROM = 2.80; P = 0.004; 95% CI = 1.41 to 5.59); and smoking (ROM = 1.76; P = 0.021; 95% CI = 1.09 to 2.86), respectively
These symptoms were associated with delay: finger swelling or discomfort (ROM = 2.72; P = 0.009, 95% CI = 1.29 to 5.74); cough (ROM = 2.53; P
Summary
Lung cancer is the commonest cause of cancer death worldwide.[1]. About seventy per cent of UK patients present in advanced stage,[2] when curative surgery is not possible. The UK's overall 5-year survival of 10%3 is low by international standards.[4] Recent approaches to improving results include: increasing awareness, screening, streamlining secondary care, and earlier identification in primary care.[5]. Improved awareness campaigns have shown short-term benefits,[6,7,8] but are hard to sustain. Low-d ose CT screening can improve mortality,[9,10] but cost-effectiveness[11] and implementation are problematic.[5,12] Despite targets in secondary care,[13] results remain poor. Interventions that target high-risk groups can improve respiratory consultation rates.[14,15]. Little is known about 'within-patient delay', which is the time from first symptom of lung cancer to contacting primary care
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