The diagnosis of lung cancer in ambulatory settings is often challenging due to non-specific clinical presentation, but there are currently no clinical quality measures (CQMs) in the United States used to identify areas for practice improvement in diagnosis. We describe the pre-diagnostic time intervals among a retrospective cohort of 711 patients identified with primary lung cancer from 2012–2019 from ambulatory care clinics in Seattle, Washington USA. Electronic health record data were extracted for two years prior to diagnosis, and Natural Language Processing (NLP) applied to identify symptoms/signs from free text clinical fields. Time points were defined for initial symptomatic presentation, chest imaging, specialist consultation, diagnostic confirmation, and treatment initiation. Median and interquartile ranges (IQR) were calculated for intervals spanning these time points. The mean age of the cohort was 67.3 years, 54.1% had Stage III or IV disease and the majority were diagnosed after clinical presentation (94.5%) rather than screening (5.5%). Median intervals from first recorded symptoms/signs to diagnosis was 570 days (IQR 273–691), from chest CT or chest X-ray imaging to diagnosis 43 days (IQR 11–240), specialist consultation to diagnosis 72 days (IQR 13–456), and from diagnosis to treatment initiation 7 days (IQR 0–36). Symptoms/signs associated with lung cancer can be identified over a year prior to diagnosis using NLP, highlighting the need for CQMs to improve timeliness of diagnosis.

ObjectiveLung cancer is the most common cause of cancer-related death in the USA. While most patients are diagnosed following symptomatic presentation, no studies have compared symptoms and physical examination signs at or prior to diagnosis from electronic health records (EHRs) in the USA. We aimed to identify symptoms and signs in patients prior to diagnosis in EHR data.DesignCase–control study.SettingAmbulatory care clinics at a large tertiary care academic health centre in the USA.Participants, outcomesWe studied 698 primary lung cancer cases in adults diagnosed between 1 January 2012 and 31 December 2019, and 6841 controls matched by age, sex, smoking status and type of clinic. Coded and free-text data from the EHR were extracted from 2 years prior to diagnosis date for cases and index date for controls. Univariate and multivariable conditional logistic regression were used to identify symptoms and signs associated with lung cancer at time of diagnosis, and 1, 3, 6 and 12 months before the diagnosis/index dates.ResultsEleven symptoms and signs recorded during the study period were associated with a significantly higher chance of being a lung cancer case in multivariable analyses. Of these, seven were significantly associated with lung cancer 6 months prior to diagnosis: haemoptysis (OR 3.2, 95% CI 1.9 to 5.3), cough (OR 3.1, 95% CI 2.4 to 4.0), chest crackles or wheeze (OR 3.1, 95% CI 2.3 to 4.1), bone pain (OR 2.7, 95% CI 2.1 to 3.6), back pain (OR 2.5, 95% CI 1.9 to 3.2), weight loss (OR 2.1, 95% CI 1.5 to 2.8) and fatigue (OR 1.6, 95% CI 1.3 to 2.1).ConclusionsPatients diagnosed with lung cancer appear to have symptoms and signs recorded in the EHR that distinguish them from similar matched patients in ambulatory care, often 6 months or more before diagnosis. These findings suggest opportunities to improve the diagnostic process for lung cancer.

Lung cancer claims more lives than any other cancer in the world and remains difficult to diagnose in the early stages. This article examines the current state of lung cancer detection and screening via low-dose computed tomography (LDCT) in Alaska and considers potential opportunities for occupational therapy practitioners in primary care settings. Medicare requires at least one documented shared decision-making encounter between provider and patient before LDCT lung cancer screening occurs. As a result of time constraints, documentation requirements, and the plethora of preventive health services they provide, primary care physicians often lack the time and training to conduct this essential service. This provides an opportunity for occupational therapy practitioners to perform these services as part of their practice and to play a role in this area as patient educators and prevention specialists in primary care settings.What This Article Adds: This article explores the national health crisis of lung cancer and describes how occupational therapists can participate in providing care in primary care settings.L ung cancer claims more lives than any other cancer in the world. In 2018, an estimated 142,670 people in the United States died from lung cancer, with an estimated 228,150 new lung cancer diagnoses (Centers for Medicare & Medicaid Services [CMS], 2020). The incidence of lung cancer is predicted to increase in developed countries, especially among women; lung cancer now claims more lives than breast cancer (Martín-Sańchez et al., 2018).Late diagnosis of lung cancer is a global concern that transcends disciplines and health care systems. Late diagnoses are attributed to many causes, such as late presentation by the patient to providers, imprecise screening tools, lack of provider knowledge about lung cancer, and gaps in health care systems with respect to referrals and follow-up care (Singh et al., 2010(Singh et al., , 2012Wagland et al., 2017). The current literature highlights a need for research from a variety of perspectives and professions to fully address the issue (Salomaa et al., 2005;Singh et al., 2007). To promote early detection of lung cancer and decrease mortality, global experts recommend more research and policies targeting early detection and diagnostic methods, including the multidimensional factors associated with lung cancer detection (Andreano et al., 2018;Wong, 2018). Late diagnosis is especially disheartening for lung cancer researchers because survival rates for people diagnosed with Stage III or IV lung cancer have increased only modestly in the past 40 yr (Johnson et al., 2014). More research, especially in geographic areas that lack access to health care, is necessary to understand the barriers to lung cancer detection in community settings (Rai et al., 2019). Literature ReviewMany screening options, such as sputum cytology, chest radiography, and low-dose computed tomography (LDCT), have been trialed to diagnose lung cancer and reduce mortality. In 2013, the U.S. Preventive Services...

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