Symptoms and other factors associated with time to diagnosis and stage of lung cancer: a prospective cohort study
Open Access
- 3 March 2015
- journal article
- research article
- Published by Springer Science and Business Media LLC in British Journal of Cancer
- Vol. 112 (1), S6-S13
- https://doi.org/10.1038/bjc.2015.30
Abstract
This prospective cohort study aimed to identify symptom and patient factors that influence time to lung cancer diagnosis and stage at diagnosis. Data relating to symptoms were collected from patients upon referral with symptoms suspicious of lung cancer in two English regions; we also examined primary care and hospital records for diagnostic routes and diagnoses. Descriptive and regression analyses were used to investigate associations between symptoms and patient factors with diagnostic intervals and stage. Among 963 participants, 15.9% were diagnosed with primary lung cancer, 5.9% with other thoracic malignancies and 78.2% with non-malignant conditions. Only half the cohort had an isolated first symptom (475, 49.3%); synchronous first symptoms were common. Haemoptysis, reported by 21.6% of cases, was the only initial symptom associated with cancer. Diagnostic intervals were shorter for cancer than non-cancer diagnoses (91 vs 124 days, P=0.037) and for late-stage than early-stage cancer (106 vs 168 days, P=0.02). Chest/shoulder pain was the only first symptom with a shorter diagnostic interval for cancer compared with non-cancer diagnoses (P=0.003). Haemoptysis is the strongest symptom predictor of lung cancer but occurs in only a fifth of patients. Programmes for expediting earlier diagnosis need to focus on multiple symptoms and their evolution.Keywords
This publication has 26 references indexed in Scilit:
- Variation in promptness of presentation among 10,297 patients subsequently diagnosed with one of 18 cancers: Evidence from a National Audit of Cancer Diagnosis in Primary CareInternational Journal of Cancer, 2014
- Patient-reported measurement of time to diagnosis in cancer: development of the Cancer Symptom Interval Measure (C-SIM) and randomised controlled trial of method of deliveryBMC Health Services Research, 2014
- A systematic review of symptomatic diagnosis of lung cancerFamily Practice, 2013
- Differences in cancer awareness and beliefs between Australia, Canada, Denmark, Norway, Sweden and the UK (the International Cancer Benchmarking Partnership): do they contribute to differences in cancer survival?British Journal of Cancer, 2013
- Reducing the time before consulting with symptoms of lung cancer: a randomised controlled trial in primary careBritish Journal of General Practice, 2013
- Understanding diagnosis of lung cancer in primary care: qualitative synthesis of significant event audit reportsBritish Journal of General Practice, 2013
- Eliciting symptoms interpreted as normal by patients with early-stage lung cancer: could GP elicitation of normalised symptoms reduce delay in diagnosis? Cross-sectional interview studyBMJ Open, 2012
- National comparisons of lung cancer survival in England, Norway and Sweden 2001-2004: differences occur early in follow-upThorax, 2010
- Experience of health changes and reasons for delay in seeking care: A UK study of the months prior to the diagnosis of lung cancerSocial Science & Medicine (1982), 2006
- Is late diagnosis of lung cancer inevitable? Interview study of patients' recollections of symptoms before diagnosisThorax, 2005