Symptoms and other factors associated with time to diagnosis and stage of lung cancer: a prospective cohort study.
BACKGROUND
This prospective cohort study aimed to identify symptom and patient factors that influence time to lung cancer diagnosis and stage at diagnosis.


METHODS
Data relating to symptoms were collected from patients upon referral with symptoms suspicious of lung cancer in two English regions; we also examined primary care and hospital records for diagnostic routes and diagnoses. Descriptive and regression analyses were used to investigate associations between symptoms and patient factors with diagnostic intervals and stage.


RESULTS
Among 963 participants, 15.9% were diagnosed with primary lung cancer, 5.9% with other thoracic malignancies and 78.2% with non-malignant conditions. Only half the cohort had an isolated first symptom (475, 49.3%); synchronous first symptoms were common. Haemoptysis, reported by 21.6% of cases, was the only initial symptom associated with cancer. Diagnostic intervals were shorter for cancer than non-cancer diagnoses (91 vs 124 days, P=0.037) and for late-stage than early-stage cancer (106 vs 168 days, P=0.02). Chest/shoulder pain was the only first symptom with a shorter diagnostic interval for cancer compared with non-cancer diagnoses (P=0.003).


CONCLUSIONS
Haemoptysis is the strongest symptom predictor of lung cancer but occurs in only a fifth of patients. Programmes for expediting earlier diagnosis need to focus on multiple symptoms and their evolution.
1] Department of Public Health & Primary Care, University of Cambridge, Cambridge CB1 8RN, UK [2] General Practice & Primary Care Academic Centre, University of Melbourne, Melbourne, Victoria, Australia.
F M
FM
Walter
School of Medicine, Pharmacy & Health, Durham University, Wolfson Building, Stockton on Tees TS17 6BH, UK.
G
G
Rubin
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK.
C
C
Bankhead
Department of Public Health & Primary Care, University of Cambridge, Cambridge CB1 8RN, UK.
H C
HC
Morris
School of Medicine, Pharmacy & Health, Durham University, Wolfson Building, Stockton on Tees TS17 6BH, UK.
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N
Hall
Department of Public Health & Primary Care, University of Cambridge, Cambridge CB1 8RN, UK.
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K
Mills
School of Medicine, Pharmacy & Health, Durham University, Wolfson Building, Stockton on Tees TS17 6BH, UK.
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C
Dobson
Department of Thoracic Oncology, Papworth Hospital NHS Foundation Trust, Cambridge CB23 3RE, UK.
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RC
Rintoul
University of Exeter, College House, St Luke's Campus, Exeter EX2 4TE, UK.
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W
Hamilton
1] Department of Public Health & Primary Care, University of Cambridge, Cambridge CB1 8RN, UK [2] General Practice & Primary Care Academic Centre, University of Melbourne, Melbourne, Victoria, Australia [3] Department of General Practice, University of Western Australia, Perth, Western Australia, Australia.
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Emery
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D002637:Chest Pain / Q000209:etiology; D015331:Cohort Studies; D003371:Cough / Q000209:etiology; D057210:Delayed Diagnosis; D004417:Dyspnea / Q000209:etiology; D004739:England; D005260:Female; D006469:Hemoptysis / Q000209:etiology; D006801:Humans; D008171:Lung Diseases / Q000150:complications / Q000175:diagnosis; D008175:Lung Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies; D012307:Risk Factors; D020069:Shoulder Pain / Q000209:etiology; D013899:Thoracic Neoplasms / Q000150:complications / Q000175:diagnosis*; D013997:Time Factors