Symptoms at lung cancer diagnosis are associated with major differences in prognosis

Abstract

We report a cohort study of survival of patients with lung cancer presenting to a single multidisciplinary team between 1997 and 2011, according to symptoms at presentation. The overall median survival of the 3800 lung cases was 183 days (95% CI 171 to 195). There was a statistically significant difference in survival between the 12 symptom groups identified both without and with adjustment for the prognostic variables of age, gender and histology (P<0.001). Compared with the cough-alone symptom group, the risks of dying or HRs were significantly higher for the groups presenting with breathlessness (HR 1.86, 95% CI 1.54 to 2.24, n=359), systemic symptoms (HR 1.91, 95% CI 1.48 to 2.45, n=95), weight loss (HR 2.46, 95% CI 1.90 to 3.18, n=106), chest pain (HR 1.96, 95% CI 1.56 to 2.45, n=159), cough with breathlessness (HR 1.59 95% CI 1.28 to 1.98, n=177), neurological symptoms (HR 3.07, 95% CI 2.45 to 3.84, n=155) and other symptom combinations (HR 2.05, 95% CI 1.75 to 2.40, n=1963). Cough may deserve particular prominence in public health campaigns.

Lung cancer symptoms at diagnosis: results of a nationwide registry study

“…The distribution of symptoms in our study was similar to that observed by Athey et al . 7 These authors observed that the most frequent symptom in stage IV was chest pain (44%), followed by cough (25%), while the most frequent symptom in stage III was cough (35%). Similarly, a British study reported that cough was the most frequent symptom, followed by dyspnoea, as did a further two Swedish and Greek studies.…”

“… 6 While many of these symptoms can manifest jointly, something that facilitates diagnosis, a good number are also associated with the extent of disease at diagnosis. The presence of symptoms has been associated with prognosis of lung cancer 7 but few studies have analysed this symptomatology by reference to disease stage at diagnosis. In addition, there are few studies that compare the presence of symptomatology in smokers versus non-smokers.…”

Knockdown of lncRNA LINC00958 inhibits the proliferation and migration of NSCLC cells by miR-204-3p/KIF2A axis

“…In the past decades, a remarkable progress has been made in therapeutic approaches such as surgery, chemotherapy, radiotherapy and immune therapy, but the five-year survival rate is still dissatisfied [4][5][6][7]. The poor outcome and high mortality are mainly due to asymptomatic early stage and late diagnosis of the disease [8,9]. Thus, it is desperate to explore novel biomarkers for an early diagnosis and treatment of NSCLC.…”

Minimising diagnostic delay in lung cancer

“…It is probable that reducing this delay may result in improvement in stage at diagnosis, especially given the exponential growth pattern of most lung cancers. This delay is particularly striking given the median life expectancy from presentation being less than 180 days 13. Holmberg et al showed that most of the excess mortality in English patients in comparison to Norwegian and Swedish patients occurred early in follow-up and postulated that this reflected poorer access to healthcare/population awareness 3.…”

“…An evaluation of the UK Department of Health’s ‘Be Clear on Cancer’ campaign, conducted in the English Midlands, found an improvement in public awareness and an increase in the presentation of lung cancer symptoms, and an in the number of cancers detected, and a significant stage shift to earlier stage at diagnosis 17. There is also evidence that patients presenting with an isolated cough, with or without haemoptysis, have earlier stage disease, higher radical treatment rates and achieve markedly improved survival compared with patients with other or multiple symptoms 13. In contrast to these findings, Ades and colleagues using case-control methodology failed to show any relationship between lung cancer symptoms recorded in primary care and disease stage, concluding that there is little prospect of improving outcomes by earlier detection of symptomatic disease 18.…”