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Research

Evaluating the delay prior to primary care presentation in lung cancer patients

Jalpa Kotecha, Allan Clark, Matthew Burton, Wei Yee Chan, Di Menzies, Ulrike Dernedde, Rachel Banham, Andrew Wilson and William Craig Martin
BJGP Open 8 December 2020; BJGPO.2020.0130. DOI: https://doi.org/10.3399/BJGPO.2020.0130
Jalpa Kotecha
1 Rheumatology, St George's Hospital, London, United Kingdom of Great Britain and Northern Ireland
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Allan Clark
2 Medical Statistics, University of East Anglia Norwich Medical School, Norwich, United Kingdom of Great Britain and Northern Ireland
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Matthew Burton
3 Respiratory Medicine, Ipswich Hospital, Ipswich, United Kingdom of Great Britain and Northern Ireland
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Wei Yee Chan
4 Haematology, University College London, London, United Kingdom of Great Britain and Northern Ireland
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Di Menzies
5 Thoracic Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom of Great Britain and Northern Ireland
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Ulrike Dernedde
6 Oncology, James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, United Kingdom of Great Britain and Northern Ireland
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Rachel Banham
7 Community Nursing Office, Norwich, United Kingdom of Great Britain and Northern Ireland
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Andrew Wilson
8 University of East Anglia Norwich Medical School, Norwich, United Kingdom of Great Britain and Northern Ireland
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William Craig Martin
9 Oncology, Norfolk and Norwich University Hospital NHS Trust, Norwich, United Kingdom of Great Britain and Northern Ireland
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  • For correspondence: craighelene@gmail.com
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Abstract

Background: Little is known about “within-patient delay”, time from first symptom of lung cancer to contacting primary care. Aim: Primary outcomes were length of within-patient delay and the proportion of total delay it represents. Secondary outcomes were factors causing delay and survival. Design and Setting: Newly diagnosed lung cancer oncology patients at two hospitals in Norfolk. Method: Patients completed questionnaires regarding onset of symptoms, whether they had delayed, and their reasons. GPs completed correlating questionnaires. Pathway times and other data were extracted from cancer registry and hospital records and outcomes obtained prospectively. Factors causing delay were compared using ratios of geometric means. Results: In 379 patients, mean within-patient delay and pre-secondary care delay were 188.6 and 241 days (61.4% and 78.5% of total delay respectively). 38.8% patients felt they had delayed. Patient-related causes of delay were denial (ratio of means (ROM) 4.36, p=0.002, 95% CIs 1.71-11.1), anxiety (3.36, 0.026, 1.16-9.76), non-recognition of symptoms (2.80, 0.004, 1.41-5.59) and smoking (1.76, 0.021, 1.09-2.86), respectively. These symptoms were associated with delay: finger swelling/discomfort (ROM=2.72, p=0.009, CIs 1.29-5.74), cough (2.53, <0.001, 1.52-4.19), weight loss (2.41, <0.001, 1.49-3.88), weakness (2.35, 0.001, 1.45-3.83), dyspnoea (2.30, 0.001, 1.40-3.80), voice change (1.90, 0.010, 1.17-3.10) and sputum (1.66, 0.039, 1.03-2.67), respectively, also having more than five symptoms (compared to 1-3) (3.69, <0.001, 2.05-6.64). No overall relation between within-patient delay and survival was seen. Conclusion: Using smoking registers, awareness literature and self-care manuals, primary care staff could liaise with ever-smokers regarding their symptoms, to ensure early referral to secondary care.

  • Clinical (general)
  • Comorbidity
  • Continuity of care
  • Clinical (physical)
  • Cardiovascular disease
  • Diabetes
  • Research methods
  • Epidemiology
  • Received July 23, 2020.
  • Accepted November 13, 2020.
  • Copyright © 2020, The Authors

This article is Open Access: CC BY license (https://creativecommons.org/licenses/by/4.0/)

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Accepted Manuscript
Evaluating the delay prior to primary care presentation in lung cancer patients
Jalpa Kotecha, Allan Clark, Matthew Burton, Wei Yee Chan, Di Menzies, Ulrike Dernedde, Rachel Banham, Andrew Wilson, William Craig Martin
BJGP Open 8 December 2020; BJGPO.2020.0130. DOI: 10.3399/BJGPO.2020.0130

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Accepted Manuscript
Evaluating the delay prior to primary care presentation in lung cancer patients
Jalpa Kotecha, Allan Clark, Matthew Burton, Wei Yee Chan, Di Menzies, Ulrike Dernedde, Rachel Banham, Andrew Wilson, William Craig Martin
BJGP Open 8 December 2020; BJGPO.2020.0130. DOI: 10.3399/BJGPO.2020.0130
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Keywords

  • Clinical (general)
  • comorbidity
  • Continuity of care
  • Clinical (physical)
  • Cardiovascular disease
  • Diabetes
  • Research methods
  • epidemiology

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