Factors contributing to the time taken to consult with symptoms of lung cancer: a cross-sectional study

• Published in: Thorax Vol. 64; no. 6; pp. 523 - 531
• Main Authors: Smith, S M, Campbell, N C, MacLeod, U, Lee, A J, Raja, A, Wyke, S, Ziebland, S B, Duff, E M, Ritchie, L D, Nicolson, M C
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Thoracic Society 01.06.2009; BMJ Publishing Group; BMJ Publishing Group LTD
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Cardiology. Vascular system; Consultants; Cross-Sectional Studies; Female; Hospitals; Humans; Lung cancer; Lung Neoplasms - complications; Lung Neoplasms - diagnosis; Male; Medical prognosis; Medical research; Medical sciences; Middle Aged; Morbidity; Patient Acceptance of Health Care - statistics & numerical data; Pneumology; Poverty Areas; Pulmonary Disease, Chronic Obstructive - complications; Qualitative research; Rural Health - statistics & numerical data; Scotland; Smoking - adverse effects; Socioeconomic Factors; Studies; Time Factors; Tumors of the respiratory system and mediastinum; Scotland; United Kingdom > UK; Europe; Lung disease; Symptomatology; Respiratory disease; Lung cancer; Cross sectional study; Bronchus disease; Anesthesia; Time; Malignant tumor; Circulatory system; Cardiology; Cancer
• ISSN: 0040-6376; 1468-3296
• DOI: 10.1136/thx.2008.096560

Objectives:To determine what factors are associated with the time people take to consult with symptoms of lung cancer, with a focus on those from rural and socially deprived areas.Methods:A cross-sectional quantitative interview survey was performed of 360 patients with newly diagnosed primary lung cancer in three Scottish hospitals (two in Glasgow, one in NE Scotland). Supplementary data were obtained from medical case notes. The main outcome measures were the number of days from (1) the date participant defined first symptom until date of presentation to a medical practitioner; and (2) the date of earliest symptom from a symptom checklist (derived from clinical guidelines) until date of presentation to a medical practitioner.Results:179 participants (50%) had symptoms for more than 14 weeks before presenting to a medical practitioner (median 99 days; interquartile range 31–381). 270 participants (75%) had unrecognised symptoms of lung cancer. There were no significant differences in time taken to consult with symptoms of lung cancer between rural and/or deprived participants compared with urban and/or affluent participants. Factors independently associated with increased time before consulting about symptoms were living alone, a history of chronic obstructive pulmonary disease (COPD) and longer pack years of smoking. Haemoptysis, new onset of shortness of breath, cough and loss of appetite were significantly associated with earlier consulting, as were a history of chest infection and renal failure.Conclusion:For many people with lung cancer, regardless of location and socioeconomic status, the time between symptom onset and consultation was long enough to plausibly affect prognosis. Long-term smokers, those with COPD and/or those living alone are at particular risk of taking longer to consult with symptoms of lung cancer and practitioners should be alert to this.