Lung cancer stage-shift following a symptom awareness campaign

Martyn P T Kennedy, Leanne Cheyne, Michael Darby, Paul Plant, Richard Milton, Jonathan M Robson, Alison Gill, Puneet Malhotra, Victoria Ashford-Turner, Kirsty Rodger, Elankumaran Paramasivam, Annette Johnstone, Bobby Bhartia, Shishir Karthik, Catherine Foster, Veronica Lovatt, Francesca Hewitt, Louise Cresswell, Victoria H Coupland, Margreet LüchtenborgRuth H Jack, Henrik Moller, Matthew E J Callister

Research output: Contribution to journalJournal articleResearchpeer-review

73 Citations (Scopus)

Abstract

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.

Original languageEnglish
JournalThorax
Volume73
Issue number12
Pages (from-to)1128-1136
Number of pages9
ISSN0040-6376
DOIs
Publication statusPublished - Dec 2018
Externally publishedYes

Bibliographical note

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Keywords

  • Abdominal Neoplasms
  • Aged
  • Aged, 80 and over
  • Diagnostic Self Evaluation
  • Early Detection of Cancer/trends
  • Female
  • General Practice/education
  • Health Education
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Lung Neoplasms/diagnostic imaging
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Primary Health Care
  • Radiography, Thoracic/trends
  • Symptom Assessment
  • United Kingdom

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