Factors contributing to the time taken to consult with symptoms of lung cancer: a cross-sectional study

Abstract

Objectives:To determine what factors are associated with the time people take to consult with symptoms of lung cancer, with a focus on those from rural and socially deprived areas. Methods: A cross-sectional quantitative interview survey was performed of 360 patients with newly diagnosed primary lung cancer in three Scottish hospitals (two in Glasgow, one in NE Scotland). Supplementary data were obtained from medical case notes. The main outcome measures were the number of days from (1) the date participant defined first symptom until date of presentation to a medical practitioner; and (2) the date of earliest symptom from a symptom checklist (derived from clinical guidelines) until date of presentation to a medical practitioner. Results: 179 participants (50%) had symptoms for more than 14 weeks before presenting to a medical practitioner (median 99 days; interquartile range 31-381). 270 participants (75%) had unrecognised symptoms of lung cancer. There were no significant differences in time taken to consult with symptoms of lung cancer between rural and/or deprived participants compared with urban and/or affluent participants. Factors independently associated with increased time before consulting about symptoms were living alone, a history of chronic obstructive pulmonary disease (COPD) and longer pack years of smoking. Haemoptysis, new onset of shortness of breath, cough and loss of appetite were significantly associated with earlier consulting, as were a history of chest infection and renal failure. Conclusion: For many people with lung cancer, regardless of location and socioeconomic status, the time between symptom onset and consultation was long enough to plausibly affect prognosis. Long-term smokers, those with COPD and/or those living alone are at particular risk of taking longer to consult with symptoms of lung cancer and practitioners should be alert to this.Only 7% of patients with lung cancer in Scotland are alive 5 years after diagnosis; 1 a similar picture exists in England and Wales.2 Five-year lung cancer survival rates in the UK are well below the average rates of Europe and America.2 So too are surgical resection rates; only 11% of patients in the UK receive curative surgery compared with 17% in Europe and 21% in North America.

Diagnosis of Lung Cancer — Improving Survival Rates

“…Patients often develop symptoms but are unaware that they could be related to a sinister cause: it appears that between 50 and 75% of lung cancer patients may not be aware of the significance of their symptoms 35,37 . Only when further symptoms develop, or their general health deteriorates, will they seek advice 33,35 . In particular, systemic symptoms such as lethargy and weight loss seem to be associated with longer delays, whereas haemoptysis tends to prompt a more rapid response 33,39 .…”

“…Public knowledge of lung cancer symptoms generally appears to be poor 35,37,40,41 . Patients often develop symptoms but are unaware that they could be related to a sinister cause: it appears that between 50 and 75% of lung cancer patients may not be aware of the significance of their symptoms 35,37 . Only when further symptoms develop, or their general health deteriorates, will they seek advice 33,35 .…”

“…Many of those presenting will have been symptomatic for many months, with reported delays to healthcare of up to 2 years 33 . Much work has focussed on investigating this, with reported median delays from onset of symptoms to presenting to health care ranging from 7 to 31 days 35,36,37,38,39 . Public knowledge of lung cancer symptoms generally appears to be poor 35,37,40,41 .…”

“…Much work has focussed on investigating this, with reported median delays from onset of symptoms to presenting to health care ranging from 7 to 31 days 35,36,37,38,39 . Public knowledge of lung cancer symptoms generally appears to be poor 35,37,40,41 . Patients often develop symptoms but are unaware that they could be related to a sinister cause: it appears that between 50 and 75% of lung cancer patients may not be aware of the significance of their symptoms 35,37 .…”

“…90% of patients are symptomatic at the time of diagnosis 32 , often experiencing multiple symptoms 33,34,35 . Many of those presenting will have been symptomatic for many months, with reported delays to healthcare of up to 2 years 33 .…”