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Clinical Topics in Lung Cancer Sx Onset and Presentation to GP and Subsequent Cancer Diagnosis

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Clinical Topics in Lung Cancer Sx Onset and Presentation to GP and Subsequent Cancer Diagnosis Poster presentations ii53 Poster presentations ............................................................... awareness of a group of LC patients and determine the interval between Clinical topics in lung cancer Sx onset and presentation to GP and subsequent cancer diagnosis. Thorax: first published as on 28 November 2005. Downloaded from Methods: The study was approved by the local research and ethics committee. Forty seven new LC diagnoses in summer 2004 were invited P1 SYMPTOMS IN LUNG CANCER: DO THEY HELP THE to participate and 29 (62%) felt well enough to be interviewed at home DIAGNOSIS? by a nurse specialist. The GP and hospital records (CT scan + bronchoscopy) were examined to verify whether the subject’s presenta- S. Bari, D. A. Stock, A. McIver, C. M. Smyth, M. J. Walshaw, M. J. Ledson. tion was cancer related (Sx-CR) or not (Sx-incidental). Liverpool Lung Cancer Unit, The Cardio Thoracic Centre, Liverpool UK Results: Participants did not differ from non-participants by age (69.1 v 65.3 years), male sex (62% v 59%) or clinical stage of disease (Stage 1- Background: Many patients with lung cancer present late, limiting the 3A, 24% v 22%; Stages 3B-4, 76% v 78%). None of the 29 subjects were treatment options and their ultimate survival. Although there is no aware of the symptoms of LC. 43% of subjects admitted to extreme consensus as to whether specific symptoms aid diagnosis, a recent study fatigue, weight loss, or cough but only 11% to haemoptysis. (Thorax 2005;60:314–15) suggested that encouraging patients to Conclusions: Salford LC patients (1) have no awareness of LC symptoms present early with symptoms might expedite management. To investigate and (2) experience significant time intervals from onset of LC Sx to the role of symptoms in the diagnosis of lung cancer further, we looked at diagnosis. Approximately two thirds of new LC diagnoses present with a cohort of patients undergoing bronchoscopy for suspected lung cancer active verified cancer symptoms and one third as incidental findings. who had presented to our large lung cancer unit over a five year period. Recommendations: (1) A large and concerted effort is required to Methods: Our lung cancer unit diagnoses up to 400 patients per year, increase public awareness of LCSx in Salford. The first step will be the and we have kept a database of 3327 patients (1713 (51%) with lung introduction of a lung cancer symptom awareness leaflet and an audit cancer) presenting with paracancer symptoms since 2000. From this, we trail will track its impact on healthcare provider services. (2) Future age and sex matched 616 cancer patients (mean age 74.5 years, 337 studies addressing LC pathway time intervals ought to identify those male) with 616 (74.2 years, 341 male) who also presented to the unit patients who are presenting with genuine LC symptoms as they with suspected lung cancer and underwent bronchoscopy but subse- experience significantly shorter patient journeys than incidental LC quently had a non-cancer diagnosis. One hundred and thirty one lung diagnoses. cancer patients (21%) and 153 non-lung cancer patients (25%) had chronic obstructive pulmonary disease (COPD). Using x2 tests, we compared common presenting symptoms which may be associated with lung cancer between the two groups. WORDING OF CHEST X RAY REPORTS CODED AS Results: Chest pain (x2 = 94, p,0.001), weight loss (x2 = 43, p,0.001), P3 ‘‘POSSIBLE LUNG CANCER’’ breathlessness (x2 = 4.5, p,0.05), voice change (x2 = 6.4, p,0.025), stridor (x2 = 7.3, p,0.001), and loss of appetite (x2 = 49, p,0.001) were more common in the lung cancer group, whereas haemoptysis D. A. Stock, C. McCann, S. Bari, K. Mohan, M. J. Ledson, M. J. Walshaw. (x2 = 7.5, p,0.01), back pain (x2 = 19, p,0.001), fever (x2 = 7.3, Liverpool Lung Cancer Unit, Royal Liverpool University Hospital and The http://thorax.bmj.com/ p,0.01), and night sweats (x2 = 8.1, p,0.01) were more common in Cardiothoracic Centre, Liverpool UK the non-lung cancer group. Cough, wheeze, and other types of pain were equally common in both groups. Background: We have had a coded chest x ray system as an aid to Conclusion: Although several symptoms were more common in the rapid referral for patients with suspected lung cancer at our lung cancer group with a subsequent diagnosis of lung cancer, other than stridor unit since 2000, and such a system is now recommended by the NICE (which was only present in 10 cases) none of these were disease specific guidelines for lung cancer care. However, these systems rely upon the and might merely reflect the increased respiratory morbidity expected in accuracy of the reporting radiologist in order to avoid wasting precious an older population of at risk individuals. As all these patients underwent secondary care resources. With this in mind, we were interested in bronchoscopy, the increased frequency of other symptoms suggesting assessing the wording used by radiologists as an indication of the infection in the non-lung cancer patients might explain the otherwise likelihood of an ultimate cancer diagnosis. on October 2, 2021 by guest. Protected copyright. unexpected finding of increased haemoptysis in this group. This study Methods: In coded x ray reports we looked for correlation(s) between from a large cohort of patients confirms that many patients with lung commonly used descriptive terms (shadowing, consolidation, collapse, cancer present with non-specific symptoms. Hence, rapid referral and prominent hilum, opacity, nodule, cavity, [lung] mass, mediastinal investigation is important in facilitating the diagnosis. widening, pleural thickening, pleural effusion) and the presence of cancer. We also noted those reports where the radiologist had specifically remarked that the appearance was either suggestive of cancer or that cancer could not be excluded. P2 NO SYMPTOM AWARENESS IN SALFORD LUNG Results: A total of 413 coded chest x ray reports were reviewed where CANCER PATIENTS: THE NEED FOR A PUBLIC HEALTH we had confirmation of the final diagnosis (cancer v non-cancer) on our AWARENESS CAMPAIGN hospital database. In 259 (62.7%) an ultimate diagnosis of cancer was made. For each descriptive term, the proportion of cases with cancer S. C. O. Taggart, M. Baxendale, K. Peplow, J. Murray. Lung Cancer Unit, was as follows: shadowing 33/62 (53.2%), consolidation 31/47 Salford Royal NHS Trust, Hope Hospital, Manchester M6 8HD, UK (66.0%), collapse 46/73 (63.0%), prominent hilum 46/82 (56.1%), opacity 28/46 (60.9%), nodule 21/31 (67.7%), cavity 4/5 (80%), Background: Many factors affect when and how patients present for [lung] mass 115/142 (81.0%), mediastinal widening 13/16 (81.3%), diagnosis of their lung cancer (LC) symptoms (Sx)—for example, fear, pleural thickening 3/10 (30.0%), pleural effusion 27/38 (71.0%) anxiety, denial, and Sx awareness, etc. These various factors play an (p = 0.0003). Of those reports indicating that the appearance was important role in the subsequent time intervals between onset of Sx and suggestive of cancer, 128/162 (79.0%) were correct. Where it was ultimate cancer diagnosis. This study was performed to establish the Sx commented that cancer could not be excluded, in only 37/97 (38.1%) was cancer ultimately diagnosed (p = ,0.0001). Conclusion: This study shows that some descriptive terms are more powerful indicators of the presence of cancer than others, with ‘‘mass’’ Abstract P2 Median time intervals for lung cancer patients (in the lung) and ‘‘mediastinal widening’’ having the strongest correlation. ‘‘Prominent hilum’’ and ‘‘shadowing’’ are the least Onset of Sx to GP Onset of Sx to diagnosis discriminatory of the selected terms. Multivariate analysis would help show these differences more accurately. Furthermore, our group of Sx-CR (n = 21) 29.0 days 115.5 days reporting radiologists appears to have good instincts as to the Sx-incidental (n = 8) 49.0 days 189.5 days Test of significance p = 0.067 p = 0.016 probability of the chest x ray abnormalities being due to cancer. These data can be fed back to the radiology department and may allow the Sx, symptoms. accuracy of future coding to be improved, thereby facilitating more efficient use of lung cancer units’ resources. www.thoraxjnl.com ii54 Poster presentations P4 VARIATION BETWEEN CHEST PHYSICIANS AND ONCOLOGISTS IN MEASUREMENT OF PERFORMANCE Study OR (fixed) STATUS OF PATIENTS WITH NON-SMALL CELL LUNG or subcategory 95% Cl CANCER 01 Subcategory J. Maguire, V. Kelly, A. Armour, C. Smyth, M. Ledson, M. Walshaw. RCT1 Liverpool Lung Cancer Unit, Cardiothoracic Centre, Thomas Drive, Liverpool RCT2 Thorax: first published as on 28 November 2005. Downloaded from L14 3PE, UK RCT3 RCT4 Performance status (PS) is the most important prognostic factor for patients with non-small cell lung cancer (NSCLC). Accurate assessment RCT5 of PS is essential to ensure appropriate selection of treatment for patients RCT6 with this disease. RCT7 We have compared assessment of patient PS by chest physicians and oncologists in 107 patients with NSCLC diagnosed in the Liverpool Lung RCT8 Cancer Unit Rapid Access Service between April 2004 and April 2005. Subtotal (95% Cl) PS was assessed by the chest physician at the patient’s first appointment and by the oncologist after diagnosis either one or two weeks later. Both assessments were made within 14 days in all cases. Fifty three patients Abstract P5. were males and 54 female. The median age was 71 years (range 39–89 years). In 40 cases (39.4%) the chest physician and oncologist agreed on the interval (CI), 0.72–092; p = 0.0008) compared with after surgical patient PS. In 38 cases (35.5%) the oncologist assessment of PS was one resection alone.
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