Lung cancer: clinical presentation and specialist referral time

Abstract

Many textbooks describe symptoms and signs of lung cancer but refer to old series of patients.To update knowledge about lung cancer presentation, a study was carried out on 1,277 consecutive lung cancer patients, who were seen in a single Institution from January 1989 to October 2002. A set of 33 anthropometric, clinical, physical, laboratory, radiological, pathological and follow-up variables was prospectively recorded for all patients. In addition, information was obtained concerning symptoms of alarm (i.e. potential concern), times to specialist referral and the mix of symptoms at presentation. Patients were carefully followed-up and their subsequent clinical course was recorded.Casual discovery with absence of symptoms occurred more frequently towards the end of the study period and the prevalence of chest pain became less common. No other time-dependent changes were found in the presenting symptoms. Delay in specialist referral was longer when presentation was provoked by cough or by the occurrence of systemic symptoms, such as weight loss, anorexia and asthenia. Referral delay was longer towards the end of the study, perhaps related to an increase in the number of elderly patients with co-morbidities. Both alarm and prevalence symptoms were strong predictors of the clinical outcome, as found in both univariate analysis (favourable: casual discovery and chest infection; unfavourable: chest pain, dyspnoea, systemic symptoms and symptoms of local or systemic dissemination) and in multivariate analysis (favourable: chest infection).Early presentation of lung cancer is characterised by a specific symptomatic pattern. Knowledge of this pattern may help to improve the rate of early diagnosis.

Is it safe to wait? The effect of surgical wait time on survival in patients with non–small cell lung cancer

“…Myrdal and colleagues 3 included patients across all pathological stages, the majority of whom were stage III or IV. In a study by Buccheri and colleagues, 4 delays in time between the presentation of first symptoms and consultation with a specialist were examined in 1277 patients with stage I-IV NSCLC. They found a small but statistically significant decrease in survival in patients with delays greater than 2 months compared with those who waited less than 2 months.…”

Wait Times for Diagnosis and Treatment of Lung Cancer: A Single-Centre Experience

“…Adherence to the foregoing recommendations has been shown to be relatively poor in multiple countries [6][7][8][9] . However, the effect of timely investigation and treatment for lung cancer on progression-free survival (pfs), relapse-free survival (rfs) after primary surgical resection, and overall survival (os) is unclear 10,11 .…”

Symptoms and Reason for a Medical Visit in Lung Cancer Patients

“…1,4,[16][17][18][19][20][21] In our study, only 5.9% of the patients were asymptomatic at the time of diagnosis, although there was an incidental diagnosis in 14.8% of cases, since although having symptoms associated with the tumour, these were not the reason for consulting. There is a wide variation between the different populations in the proportion of those diagnosed incidentally.…”