Lung Cancer Still Most Commonly Diagnosed in Emergency Admissions

Tim Locke

January 31, 2020

DUBLIN — A report from the UK Lung Cancer Coalition (UKLCC) calls it a "travesty" that emergency admissions remain the most common setting for lung cancer diagnoses.

The report, Early Diagnosis Matters , was released to coincide with the British Thoracic Oncology Group (BTOG) annual meeting in Dublin.

It found patients getting an emergency diagnosis are over five times more likely to die within a year than those referred for treatment by their GP.

The report concedes there's no single 'silver bullet' solution but makes a series of recommendations, including:

  • Continuing funding of lung cancer awareness campaigns

  • Smoking cessation services to use patient contact to raise awareness of lung cancer symptoms

  • Better lung cancer training for GPs

  • Comprehensive rollout of England's new 28-day cancer Faster Diagnosis Standard and National Optimal Lung Cancer Pathway

  • Wider healthcare community referrals for suspected lung cancer cases, including from nurses and pharmacists

  • Making sure all areas follow best practice to help earlier diagnosis of lung cancer

   

Prof Mick Peake

One of the report's authors, Professor Mick Peake, clinical director, Centre for Cancer Outcomes, and chair of the UKLCC's Clinical Advisory Group spoke to Medscape UK.

Q&A

What's behind the headline figures?

In 2006, 25% of all cancers in the UK we found were being picked up as part of an emergency assessment. In lung cancer, it was just over, 40%.

That figure had dropped year on year to about 32% so there's been a lot of work on this.

But it still means that around a third of lung cancer patients are first being picked up as part of an emergency admission.

We know that if you're old, and if you're socially deprived, you're more likely to come through as an emergency.

If you look at where [patients] live by CCG (clinical commissioning group), you're over four times more likely to come through an emergency route, if you live in one part of the country than the other.

We don't really understand that.

How can the situation be improved?

I've been leading on public awareness campaigns, the Be Clear on Cancer stuff. So, coughing for more than 3 weeks, go and see your GP.

We've been working with general practice to try and increase their awareness.

It's a complex area, and it's partly the population. If you've got a very old or socially deprived ethnically mixed area, how you get across the messages and whether they respond culturally to them [may not be] the same.

Are there missed opportunities in primary care or other health appointments?

If you look at people who are diagnosed with chest X-rays, we know they're seen on average at least three times by GPs the previous year. And we know the number of chest X-rays starts to increase about 9 months before referral. So there are lots of missed opportunities there.

I think one of the things that public awareness campaigns did was give GPs 'permission' to send low-risk patients in.

You go back a few years and a GP would send a low-risk patient to the hospital and the hospital specialist would send back a letter to say 'don't waste my time with this, this patient's got nothing'.

That sort of resistance is much less. So, GPs feel empowered, without being unduly criticised - because they're also criticised for sending them in too late as well.

They're stuck between a rock and a hard place.

'Travesty' is a strong word to use.

It's a travesty in terms of public health.

We're not trying to say Dr X or area Y is really terrible.

We think if everywhere was applying best practice we could get 5-year 25% lung cancer survival next week.

Prof Peake reports no relevant conflicts of interest.

British Thoracic Oncology Group (BTOG),  18th Annual Conference 2020,  Dublin, 29th to 31st January 2020.

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