Symptom lead time distribution in lung cancer: natural history and prospects for early diagnosis

Ades, A E; Biswas, Mousumi; Welton, Nicky J; Hamilton, William

doi:10.1093/ije/dyu174

Cited by 43 publications

(53 citation statements)

References 16 publications

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“…An analysis of a UK-based case–control study18 estimated a symptom lead time for lung cancer of only 2 to 3 months 19. The authors argue that expediting a diagnosis by this interval may not be sufficient to result in a stage-shift, and thus any stage-shift demonstrated in the context of a symptom awareness campaign may instead reflect the incidental diagnosis of lung cancer in patients with symptoms of other causes.…”

Section: Discussionmentioning

confidence: 99%

Lung cancer stage-shift following a symptom awareness campaign

Kennedy

Cheyne

Darby

et al. 2018

Thorax

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Section: Discussionmentioning

confidence: 99%

Lung cancer stage-shift following a symptom awareness campaign

Kennedy

Cheyne

Darby

et al. 2018

Thorax

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“…Symptoms of lung cancer are often subtle and nonspecific, leading to delays in diagnosis [2–5]. In some patients, the disease is diagnosed incidentally, without symptoms of lung cancer, during work-up for unrelated disease.…”

Section: Introductionmentioning

confidence: 99%

Incidental detection by computed tomography is an independent prognostic factor for survival in patients operated for nonsmall cell lung carcinoma

et al. 2017

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We studied the rate of incidental detection of lung carcinomas and its effect on long-term survival in a nationwide cohort of patients operated for nonsmall cell lung cancer (NSCLC).All patients operated for NSCLC in Iceland during 1991–2010 were included. Demographic and clinicopathological features were compared in patients diagnosed incidentally using chest radiography or computed tomography (CT), and in those with symptomatic presentation. Multivariate analysis was used to evaluate prognostic factors.Out of 508 patients, 174 (34%) were diagnosed incidentally; in 26% of cases by chest radiography and in 8% by CT. The CT-detected tumours were significantly smaller than symptomatic tumours, diagnosed at earlier TNM (tumour, node and metastasis) stages and more often of adenocarcinoma histology. 5-year cancer-specific survival for symptomatic versus incidentally diagnosed patients detected by chest radiography and CT was 41%, 57% and 68%, respectively (p=0.003). After adjusting for stage, the hazard ratio (HR) for NSCLC mortality was significantly lower for incidental diagnosis by CT (HR 0.55, 95% CI 0.31‒0.98; p=0.04) compared to incidental diagnosis by chest radiography (HR 0.95, 95% CI 0.70‒1.27; p=0.71) or symptomatic diagnosis (HR 1.0).One-third of surgically treated NSCLCs were detected incidentally, with an increasing rate of incidental CT diagnosis. NSCLC patients diagnosed incidentally by CT appear to have better survival than those diagnosed incidentally by chest radiography, and particularly those who present with symptoms.

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“…It may be that primary care clinicians have poorer access to X-ray facilities than their specialist colleagues, and there is evidence that lung cancer patients presenting to hospital in the UK without a suspicious chest X-ray are less likely to have specialist care or histological confirmation of their cancer, and they have lower rates of active treatment [33]. There is also evidence that, where a chest X-ray for a patient with lung cancer does originate in primary care, there is an earlier stage at diagnosis [34]. There may be confounding factors: for instance, inequality in the treatment given to lung cancer patients could be due to variations in access to oncology services, with evidence for longer survival in patients whose first hospital attendance is at a radiotherapy centre [35].…”

Section: Discussionmentioning

confidence: 99%

How the probability of presentation to a primary care clinician correlates with cancer survival rates: a European survey using vignettes

Harris

Frey

Esteva

et al. 2017

Scandinavian Journal of Primary Health Care

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ObjectiveEuropean cancer survival rates vary widely. System factors, including whether or not primary care physicians (PCPs) are gatekeepers, may account for some of these differences. This study explores where patients who may have cancer are likely to present for medical care in different European countries, and how probability of presentation to a primary care clinician correlates with cancer survival rates.DesignSeventy-eight PCPs in a range of European countries assessed four vignettes representing patients who might have cancer, and consensus groups agreed how likely those patients were to present to different clinicians in their own countries. These data were compared with national cancer survival rates.SettingA total of 14 countries.SubjectsConsensus groups of PCPs.Main outcome measuresProbability of initial presentation to a PCP for four clinical vignettes.ResultsThere was no significant correlation between overall national 1-year relative cancer survival rates and the probability of initial presentation to a PCP (r = −0.16, 95% CI −0.39 to 0.08). Within that there was large variation depending on the type of cancer, with a significantly poorer lung cancer survival in countries where patients were more likely to initially consult a PCP (lung r = −0.57, 95% CI −0.83 to −0.12; ovary: r = −0.13, 95% CI −0.57 to 0.38; breast r = 0.14, 95% CI −0.36 to 0.58; bowel: r = 0.20, 95% CI −0.31 to 0.62).ConclusionsThere were wide variations in the degree of gatekeeping between countries, with no simple binary model as to whether or not a country has a “PCP-as-gatekeeper” system. While there was case-by-case variation, there was no overall evidence of a link between a higher probability of initial consultation with a PCP and poorer cancer survival.Key pointsEuropean cancer survival rates vary widely, and health system factors may account for some of these differences.The data from 14 European countries show a wide variation in the probability of initial presentation to a PCP.The degree to which PCPs act as gatekeepers varies considerably from country to country.There is no overall evidence of a link between a higher probability of initial presentation to a PCP and poorer cancer survival.

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Symptom lead time distribution in lung cancer: natural history and prospects for early diagnosis

Abstract: Most symptoms preceded clinical diagnosis by only a few months. Symptom-based investigation would lengthen lead times and result in earlier stage at diagnosis in a small proportion of cases, but would be far less effective than standard screening targeted at smokers.

Cited by 43 publications

References 16 publications

Lung cancer stage-shift following a symptom awareness campaign

Lung cancer stage-shift following a symptom awareness campaign

Incidental detection by computed tomography is an independent prognostic factor for survival in patients operated for nonsmall cell lung carcinoma

How the probability of presentation to a primary care clinician correlates with cancer survival rates: a European survey using vignettes

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