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Research project: A pilot study to investigate an approach to researching the symptom complexes associated with early and late stage lung cancer, and the factors associated with delay in presentation and diagnosis of lung cancer - Dormant - Dormant

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Lung cancer is the commonest cancer in the UK accounting for 1 in 7 new cancer cases (over 40,000 new patients are diagnosed annually). The disease has a poor prognosis and consequently is also the commonest cause of cancer deaths. Overall, less than 10% of patients are alive 5 years after diagnosis and most die within the first year.


The Government's health strategy 'Our Healthier Nation' aims to reduce lung cancer deaths by at least 30% in men and 15% in women under 75 by 2010. Action to increase early diagnosis of the disease could also have a significant impact on survival. An increase in the proportion of patients undergoing potentially curative surgery would impact on survival rates and assist in the achievement of targets set out in 'The Cancer Plan'.

Main question(s)

  • To develop and evaluate a method for gathering detailed information about (a) the symptom history of patients prior to a diagnosis of lung cancer and (b) the health professional and system response to patients following presentation with symptoms
  • To identify factors associated with delay and symptom clusters that may be associated with different stages of lung cancer
  • To gather information about the symptoms and events preceding diagnosis so a more detailed picture of the pathway to diagnosis might be developed
  • To assess whether it may be possible to differentiate between patients eligible for surgery and patients with advanced or inoperable disease
  • A secondary purpose was to assess the feasibility of mounting a larger follow up study


The study was conducted in two phases:

  • A secondary analysis of existing data collected from recently diagnosed patients was used to identify firstly, symptom complexes associated with lung cancer and secondly, factors associated with delay in presentation
  • The development of a structured interview schedule that was piloted among patients with lung cancer

Main outcomes

Findings from Phase 2 suggest that the widely held view that lung cancer is silent until far advanced may be inaccurate. Patients recalled having symptoms for many months prior to diagnosis regardless of their disease status at diagnosis.

A total of 30 different symptoms were experienced prior to diagnosis. The quantity and pattern of symptoms recalled was similar for patients who were operable or inoperable at diagnosis. The most common symptoms were chest symptoms. Other symptoms less obviously associated with lung cancer included weakness, weight loss or appetite change. Typically there was a gradual accumulation of problems such as chest pain, lethargy, weight loss and shortness of breath or an increase in the severity of symptoms over time before the patient acted on them.

Key events in the pathway to diagnosis were mapped for each patient over a 2-year period prior to diagnosis. The first change in health status was recalled by most patients as having occurred many months prior to diagnosis. There were no apparent differences between operable and inoperable patients.

The directed interview approach was found to be feasible and reliable in eliciting information about pre-diagnosis history in lung cancer. It appears patients may have symptoms for many months or even years prior to their eventual diagnosis, regardless of their disease status at diagnosis, suggesting that there may be scope for earlier diagnosis.

Patient behaviour rather than GP behaviour or system failure seems to be the most important, although not the only determinant of delay among the 22 patients interviewed.
A study to confirm whether these findings are typical of the pathway to diagnosis in lung cancer is recommended.

Project team

Jessica Corner

Project funder

Department of Health, Policy Research Programme 2003

Related research groups

Complex Healthcare Processes

Key Publications

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