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Lung cancer stage-shift following a symptom awareness campaign
  1. Martyn P T Kennedy1,
  2. Leanne Cheyne2,
  3. Michael Darby3,
  4. Paul Plant4,
  5. Richard Milton5,
  6. Jonathan M Robson1,
  7. Alison Gill6,
  8. Puneet Malhotra7,
  9. Victoria Ashford-Turner1,
  10. Kirsty Rodger1,
  11. Elankumaran Paramasivam1,
  12. Annette Johnstone3,
  13. Bobby Bhartia3,
  14. Shishir Karthik3,
  15. Catherine Foster8,
  16. Veronica Lovatt9,
  17. Francesca Hewitt10,
  18. Louise Cresswell11,
  19. Victoria H Coupland12,
  20. Margreet Lüchtenborg12,13,
  21. Ruth H Jack12,
  22. Henrik Moller14,
  23. Matthew E J Callister1
  1. 1 Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, St James’s University Hospital, Leeds, UK
  2. 2 Department of Respiratory Medicine, Bradford Royal Infirmary, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
  3. 3 Department of Clinical Radiology, Leeds Teaching Hospitals NHS Trust, St James’s University Hospital, Leeds, UK
  4. 4 Department of Thoracic Medicine, Aintree University Hospital NHS Foundation Trust, Aintree University Hospital, Liverpool, UK
  5. 5 Department of Thoracic Surgery, Leeds Teaching Hospitals NHS Trust, St James’s University Hospital, Leeds, UK
  6. 6 Department of Respiratory Medicine, York Hospitals NHS Foundation Trust, York, UK
  7. 7 Department of Respiratory Medicine, St Helens and Knowsley Teaching Hospitals NHS Trust, Lancashire, UK
  8. 8 NHS Leeds West Clinical Commissioning Group, Leeds, UK
  9. 9 St Gemma’s Hospice, previously Leeds Primary Care Trust, Leeds, UK
  10. 10 Leeds Teaching Hospitals NHS Trust, St James’s University Hospital, Leeds, UK
  11. 11 Public Health, Leeds City Council previously Leeds Primary Care Trust, Leeds, UK
  12. 12 National Cancer Registration and Analysis Service, Public Health England, London, UK
  13. 13 Cancer Epidemiology, Population and Global Health Programme, School of Cancer and Pharmaceutical Sciences, King’s College London, London, UK
  14. 14 School of Cancer and Pharmaceutical Sciences, King’s College London, London, UK
  1. Correspondence to Dr Matthew E J Callister, Leeds Teaching Hospitals NHS Trust, St James University Hospital, Leeds, LS9 7TF, UK; matthew.callister{at}


Background Lung cancer outcomes in the UK are worse than in many other developed nations. Symptom awareness campaigns aim to diagnose patients at an earlier stage to improve cancer outcomes.

Methods An early diagnosis campaign for lung cancer commenced in Leeds, UK in 2011 comprising public and primary-care facing components. Rates of community referral for chest X-ray and lung cancer stage (TNM seventh edition) at presentation were collected from 2008 to 2015. Linear trends were assessed by χ2 test for trend in proportions. Headline figures are presented for the 3 years pre-campaign (2008–2010) and the three most recent years for which data are available during the campaign (2013–2015).

Findings Community-ordered chest X-ray rates per year increased from 18 909 in 2008–2010 to 34 194 in 2013–2015 (80.8% increase). A significant stage shift towards earlier stage lung cancer was seen (χ2(1)=32.2, p<0.0001). There was an 8.8 percentage point increase in the proportion of patients diagnosed with stage I/II lung cancer (26.5% pre-campaign vs 35.3% during campaign) and a 9.3% reduction in the absolute number of patients diagnosed with stage III/IV disease (1254 pre-campaign vs 1137 during campaign).

Interpretation This is the largest described lung cancer stage-shift in association with a symptom awareness campaign. A causal link between the campaign and stage-shift cannot be proven but appears plausible. Limitations of the analysis include a lack of contemporary control population.

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  • MPTK and LC contributed equally.

  • Contributors Conception and design of study: MD, PP, RM, CF, VL, FH, VHC, LCr, ML, RHJ, HM, MEJC. Acquisition of data: MPTK, LCh, MD, PP, RM, JMR, AG, PM, VA-T, KR, EP, AJ, BB, SK, MEJC. Analysis of data: MPTK, LCh, VHC, ML, RHJ, HM, MEJC. Interpretation of data: MPTK, LCh, MD, VHC, ML, RHJ, HM, MEJC. Drafting the work or revising critically for important intellectual content: all authors. Final approval of version to be published: all authors. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: all authors.

  • Funding The campaign was funded by NAEDI (UK Department of Health; co-chaired by Cancer Research UK) 2011, NHS Leeds Primary Care Trust (2011–2013), the three Leeds Clinical Commissioning Groups (2013–current) and Leeds City Council (2013–current).

  • Disclaimer NAEDI, the UK Department of Health, Cancer Research UK and Leeds City Council had no role in study design, data collection, interpretation, analysis nor in the writing and submitting process.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval The study was registered with the UK Clinical Research Network Study Portfolio (UKCRN ID 9447) and received ethics committee approval (MREC No. 10/H1302/81).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Author note Coauthors employed by the Primary Care Trust and Clinical Commissioning Groups were members of the early diagnosis campaign team, and have been involved in study design, interpretation of data, report writing and the decision to submit for publication.

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