RT Journal Article
SR Electronic
T1 Evaluating the delay prior to primary care presentation in patients with lung cancer: a cohort study
JF BJGP Open
JO BJGP Open
FD Royal College of General Practitioners
SP BJGPO.2020.0130
DO 10.3399/BJGPO.2020.0130
VO 5
IS 2
A1 Kotecha, Jalpa
A1 Clark, Allan
A1 Burton, Matthew
A1 Chan, Wei Yee
A1 Menzies, Di
A1 Dernedde, Ulrike
A1 Banham, Rachel
A1 Wilson, Andrew
A1 Martin, William Craig
YR 2021
UL http://bjgpopen.org/content/5/2/BJGPO.2020.0130.abstract
AB Background Little is known about 'within-patient delay', which is the 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 & setting A cohort study of newly diagnosed patients with lung cancer 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 days and 241 days (61.4% and 78.5% of total delay, respectively). It was found that 38.8% of patients felt they had delayed. Patient-related causes of delay were denial (ratio of means [ROM] = 4.36; P = 0.002, 95% confidence interval [CI] = 1.71 to 11.1); anxiety (ROM = 3.36; P = 0.026; 95% CI = 1.16 to 9.76); non-recognition of symptoms (ROM = 2.80; P = 0.004; 95% CI = 1.41 to 5.59); and smoking (ROM = 1.76; P = 0.021; 95% CI = 1.09 to 2.86), respectively. These symptoms were associated with delay: finger swelling or discomfort (ROM = 2.72; P = 0.009, 95% CI = 1.29 to 5.74); cough (ROM = 2.53; P<0.001; 95% CI = 1.52 to 4.19); weight loss (ROM = 2.41; P<0.001; 95% CI = 1.49 to 3.88); weakness (ROM = 2.35; P = 0.001; 95% CI = 1.45 to 3.83); dyspnoea (ROM = 2.30; P = 0.001; 95% CI = 1.40 to 3.80); voice change (ROM = 1.90; P = 0.010; 95% CI = 1.17 to 3.10); and sputum (ROM = 1.66; P = 0.039; 95% CI = 1.03 to 2.67), respectively, also having more than five symptoms (compared with 1–3) (ROM = 3.69; P<0.001; 95% CI = 2.05 to 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 people who have ever smoked regarding their symptoms to ensure early referral to secondary care.