Abstract
Patterns of general practice utilization in the period before lung cancer (LC) diagnosis may provide new knowledge to ensure timelier and earlier diagnosis of LC. This study aimed to explore the prediagnostic activity in general practice in the year preceding LC diagnosis. The activity was compared to a matched comparison group. We compared LC patients with different stage, and patients with and without chronic obstructive pulmonary disease (COPD). Using Danish registers, we performed a population‐based matched cohort study including lung cancer patients (n = 34,017) and matched comparison subjects (n = 340,170). During months 12 to 1 prior to diagnosis, 92.6% of LC patients and 88.4% of comparison subjects had one or more contacts with general practice. 13.0% of LC patients and 3.3% of comparison subjects had two or more X‐rays. 20.8% of LC patients and 8.5% of comparison subjects had two or more first‐time antibiotics prescriptions. The incidence rate ratio for having a contact to general practice was similar for LC patients with localized disease compared to LC patients with metastatic disease. LC patients with COPD had more frequent contacts, lung functions tests, X‐rays, and prescriptions than COPD patients without lung cancer, but not as pronounced as compared to patients without COPD. There was a significant increase in healthcare seeking and diagnostic activity in the year prior to a LC diagnosis, regardless of stage at diagnosis. COPD may mask the symptoms of LC. This indicates the presence of a “diagnostic time window” and a potential for more timely diagnosis of LC based on clinical signs and symptoms.
Highlights
Lung cancer is a significant health problem worldwide and the most common cause of cancer death in the industrialized world [1]
This study aimed to explore the prediagnostic activity in general practice in the year preceding lung cancer (LC) diagnosis
We identified patients as having chronic obstructive pulmonary disease (COPD) if they in the period 12–36 months before lung cancer diagnosis had either at least two redeemed prescriptions of relevant medicine, an inpatient visit (See appendix, Table 1, for the ICD10 codes for the inpatient visit) or at least two lung function tests performed in general practice [20]
Summary
Lung cancer is a significant health problem worldwide and the most common cause of cancer death in the industrialized world [1]. Survival from lung cancer is related to the stage of disease, and 5-year survival is 50% for localized lung cancer and 2% for a lung cancer with distant spread. Danish lung cancer patients have lower survival than patients from comparable European countries [3, 4]. This can possibly be explained by later diagnosis of lung cancer in Denmark and research indicates a lower proportion of lung cancer patients in curable stage in Denmark compared to Norway and Sweden [5]. It is possible that the survival deficit in Danish patients may relate to processes of cancer awareness and diagnostic activity at the level of primary care. Delay in diagnosis before admission to a hospital can be due to either patients delaying going to the general practitioner (GP) (the so called patient’s interval) or the GP delaying
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