Why focus on symptomatic lung cancer?
Lung cancer is the largest cause of cancer death, with 1.8 million deaths worldwide per year.1 Despite important improvements in treatment, outcomes remain poor compared with other common cancers. In England and Wales 1-year survival is only 48%.2 Stage of cancer and performance status (PS) are the strongest independent predictors of survival. The adjusted hazard ratio for death was 4.39 for PS 4 (the most impaired PS category) compared with PS 0 (the least impaired category) and 4.58 for stage IV compared with IA–IB in the English National Lung Cancer Audit.3 Unfortunately, almost half of patients with lung cancer are diagnosed with stage IV disease in England4 and 47% of patients present at PS 2–45 when they are not eligible for most systemic treatments. Furthermore, systemic treatments are more effective in patients who are fitter. Achieving diagnosis of lung cancer in earlier stages of the disease is therefore crucial to improving survival.
Targeted screening using low-dose computed tomography (LDCT) is an important way to reduce lung cancer mortality, and implementing national programmes across the UK following the recommendation of the National Screening Committee is vital.6 However, the majority of patients will continue to present via the symptomatic route. More than half of lung cancers arise in people who would not meet the eligibility criteria for screening7 and, of those eligible, only around half choose to participate.8
Evidence suggests there is an opportunity to bring forward the diagnosis in people with symptoms and, given that many patients deteriorate prior to diagnosis, this could have important impacts on treatment eligibility and efficacy. The median symptom lead time to diagnosis of lung cancer is 3 months,9 and 33% of those with lung cancer who attend general practice before diagnosis have three or more consultations …
