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‘GPs must improve lung cancer diagnosis’

14 October 2014

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General practitioners needs more help to spot the signs of lung cancer, researchers have claimed. 

New figures published in the journal Thorax show that in three UK lung cancer patients die within three months of diagnosis, despite visiting general practice many times. 

Researchers from the University of Nottingham expressed concern that family doctors may not be picking up signs of lung cancer and investigating them appropriately or fast enough. 

Data from The Health Improvement Network (THIN) on GP investigation of lung cancer between 200 and 2013 was analysed. In total, 20,142 cases of lung cancer were recorded by 444 general practices during the study period. 

One in 20 (5%) had lung cancer recorded only on the death certificate. In the rest, one in ten patients died within a month of diagnosis, and one in seven (15%) died within three months. These were classified as early deaths. 

More than half (57%) of all lung cancer deaths were in men, who are also 17% more likely to die early than women. 

The average age of diagnosis was 72. Those aged 80 and above were 80% more likely to die early than those who were diagnosed at a younger age.

And an early death was 16% more likely in areas of high deprivation than in more affluent areas. Living in a rural area also increased the odds of an early death from lung cancer.

Survival rates for lung cancer in the UK lag behind other counties, which has previously be attributed to late diagnosis. 

Patients who died early went to see their GP more frequently in the few months before their diagnosis, visiting their general practice an average of five times.

The odds of an early death were lower among those who had had a chest x ray carried out in primary care, irrespective of how many times they had seen their GP before diagnosis. But the odds of an early death rose in tandem with the number of GP consultations they had had.

The researchers point out that the average family doctor is likely to see only one new case of lung cancer a year.

“For this reason we need to promote better use of risk assessment tools, and use software prompts to help GPs to identify and investigate in a timely manner those at risk,” they write. “This has potential to increase the proportion of patients who are diagnosed at an early stage and are, therefore, suitable for treatment with curative intent.”

In a linked editorial, Dr Michael Peake, honorary consultant and senior lecturer at the University of Leicester’s Glenfield Hospital, agrees that GPs need better tools to support their clinical decision making, so that they can pick up patients at risk earlier on.

And he insists: “The number of excess deaths linked to deprivation is large and the gap between the least and most deprived has not lessened over time. Improved targeting of public awareness campaigns to specific social groups is important so as not to widen this gap further.”

Dr Richard Roope, Royal College of General Practitioners Cancer Lead, said: “Lung cancer is notoriously difficult to diagnose in primary care, especially as a key symptom is coughing, which is present with numerous other conditions that GPs see every day.

“GPs are doing a good job of appropriately referring our patients that we suspect of having cancer and 75% of patients found to have cancer are referred after only one or two GP consultations. And it is very encouraging that one-year survival rates for lung cancer are improving.

“Instead of criticising GPs, we need to invest in general practice to allow us to employ more GPs and support staff and to give GPs more access to technology that could ultimately save our patients’ lives.”

The study is available to view online