Is late diagnosis of lung cancer inevitable?

A study by researchers into the diagnosis of patients with lung cancer suggests that avoidable patient delays in reporting symptoms of the disease is an important factor in its treatment.

The research, carried out by the University of Southampton, The Cambridge Institute of Public Health and Leeds General Infirmary, indicates that the widely held view that lung cancer is silent until far advanced may be inaccurate.

Lung cancer remains the most common cause of death from cancer in the UK with over 33,000 deaths a year. Delay in the diagnosis of cancer is recognised as an important factor in the overall outcome of treatment. Currently, little is known about the pathway to diagnosis for cancer, especially lung cancer. However there is evidence to suggest that avoidable delays in diagnosis occur and that these are attributable to both doctor and patient behaviour.

In this new study, researchers interviewed 22 patients recently diagnosed with lung cancer at two cancer centres in the north and south of England. The interviews were used to map the history of their symptoms leading up to the diagnosis. Patients were asked to describe the nature and number of symptoms they recalled before diagnosis and to pinpoint when the health changes that ultimately led to the diagnosis of lung cancer started. Recollections more than two years before the diagnosis were not recorded as they were deemed to be insufficiently detailed. The accounts were compared with hospital and primary care records to check patients' recall.

All the patients recalled having new symptoms for many months prior to their diagnosis. A total of 30 different symptoms were experienced by patients before diagnosis, ranging from chest symptoms such as cough and breathing changes to fatigue, lethargy or weight loss which is considered to be a symptom of the advanced disease.

Although these symptoms were reported as being marked changes in their health, patients did not interpret these changes as serious or as symptoms of lung cancer and did not see their GP to discuss them. Instead they frequently sought to manage the problem themselves until it became too difficult.

Despite the fact that all but one of the patients were current or former smokers, it appeared that symptoms such as breathing changes or profound fatigue were not associated with the possibility that these might be symptoms of lung cancer. Instead, symptoms were attributed to everyday causes such as getting older.

Professor Jessica Corner, Professor of Palliative Care at the University of Southampton and Director for Improving Cancer Services, Macmillan Cancer Relief, comments: 'These results indicate that developing greater understanding of how people respond to changes in their health - especially when these are a prelude to a disease that holds very negative commutations such as lung cancer - could be used to inform the development of strategies to promote earlier diagnosis.

'There is a clear need for different approaches to public health whereby people at risk are encouraged to be more conscious of their health and to the possibility that they may develop lung cancer. If successful, this may lead to earlier presentation, faster diagnosis and better outcomes.'

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