Article Text


Lung cancer: clinical studies
P199 A study of symptoms and pathways to treatment in lung cancer patients
  1. U Dernedde1,
  2. R Banham2,
  3. Z Tasigiannopoulos2,
  4. T Roques2,
  5. A Wilson3,
  6. A Clark3,
  7. C Martin2
  1. 1James Paget University Hospital, Great Yarmouth, UK
  2. 2Norfolk and Norwich University Hospital, Norwich, UK
  3. 3University of East Anglia, Norwich, UK


Introduction and Objectives Cancer targets promote shorter times within secondary care. However, primary care delays may be longer. Our aim was to study symptoms by asking patients themselves to record their own and any perceived delays in their pathway to treatment.

Methods 259 lung cancer patients were invited, at their first oncology visit, to complete questionnaires derived from the EORTC -LC13, including urgent and systemic symptoms and to date their start to the nearest week, when they saw their GP, whether they delayed doing so and why and how often they saw their GP before being referred for CXR or to secondary care. The GP was also mailed.

Results Mean within-patient delay was 81 days (median 24). Mean delay from seeing GP to MDT meeting was 115 days (median 70), mean delay from MDT to oncology treatment was 25 days (median 15). 38% of patients admitted having delayed to see their GP. Commonest reasons were worry, denial, being too busy or family reasons. 38% patients were referred for CXR/to secondary care on their first GP visit, 49% on 2nd–3rdvisit, 12% four visits or more. Analysis of variance showed no relation between stage and time to oncology. Initially, cough, dyspnoea, haemoptysis, chest pain, sputum were present in 29%, 30%, 11%, 9% and 13% of patients respectively. However, when patients were seen at oncology, these had risen to 76%, 78%, 30%, 41% and 61% respectively. Staging was available in 255 patients with stage I, II, III and IV as 6%, 8%, 40% and 46% respectively. Systemic symptoms were frequent: asthenia 64%, weight loss 60%, anorexia 47%, dry mouth 41% and altered taste 35%. Anorexia, xerostomia, altered taste, pain other than chest pain, analgesic usage and dysphagia were each correlated with stage IV rather than I–III tumours (all p<0.05).


  • 1) Delay within-patient was significantly longer than within-oncology (p<0.0001).

  • 2) Over 60% patients visited their GP more than once.

  • 3) Delay and stage were unrelated in our study.

  • 4) Chest symptoms increased considerably during the pathway to treatment.

  • 5) A number of common symptoms were associated with advanced disease.

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