8th June 2023

A spotlight on symptoms

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There is no doubt screening will be the biggest step forward in the early detection of lung cancer. However, as momentous as this will be, it is by no means the complete solution.

The targeted nature of the programme, screening those at highest risk of developing the disease, means the majority of people with lung cancer will still be diagnosed through the symptomatic pathway and we see it as our responsibility to lead the charge on finding ways to improve earlier detection in people experiencing symptoms.

40 heads are better than one

On Wednesday 8th March, we gathered around 40 healthcare professionals across the lung cancer pathway – from GPs to radiographers, chest physicians and oncologists, as well as key members from NHS Cancer Programme team – to begin generating ideas.

Recognising the current hurdles many face with accessing primary care, conversations soon steered towards additional routes to diagnosis. Consultant Chest Physician Dr Matthew Evison, shared details of a new drop-in chest x-ray service being piloted in areas of Greater Manchester.

Residents in Bury, Heywood, Rochdale and Middleton aged 40 or over with selected ongoing symptoms, including a cough, shortness of breath or fatigue, for three weeks or more are now able to have a chest x-ray without needing to see a GP.

“We want to make it as easy as possible for people with symptoms to get checked,” explains Dr Evison.

“The roll out of this scheme not only intends to offer peace of mind for many who may be experiencing niggling worries about their health, but also expose the cases which may need extra attention quickly.

“Conditions like lung cancer are much more treatable when they are caught early, so this service hopes to make timely diagnosis, and help prolong life.

“The service has been a great success so far, with lots of people reportedly dropping into the three participating hospitals – Fairfield Hospital, The Royal Oldham Hospital and Rochdale Infirmary.”

Whilst not an infallible diagnostic tool, chest x-ray remains the starting point for most people’s lung cancer journey. However, during our workshop it was suggested that there was perhaps a hesitancy for GPs to refer patients for x-ray.

This is something we followed up on with radiographer, Dr Nick Woznitza, discussing the role fellow radiographers and radiologists could play in easing concerns and encouraging GPs to send those with symptoms for chest x-ray.

“It’s understandable why there may be some hesitancy about referring patients for x-ray, or concerns that a referral may be rejected. I have never known of a radiographer to reject a request for chest x-ray for suspected lung cancer; the only reason it may be queried is because the patient had had another x-ray recently. I think this is an important message to get across and provide reassurance to GPs, especially as x-rays can help us pick up lots of conditions, not just lung cancer.”

Dr Katherine Hickman, a GP in Braford, agrees. “Chest x-rays are such a useful test for so many different things. As a GP, it is normal for us to send a patient for bloods test for all sorts of symptoms. It would be big step forward if we could normalize chest x-rays in the same way.”

We are now working with Dr Hickman and Dr Woznitza to understand and overcome the barriers for sending people for chest x-ray and improve communication between primary and secondary care.

Let’s Talk Lung Cancer

With ideas to tackle the hurdles within primary care taking shape, attention turned to a wider issue – before a person even gets into a GP consultancy room.

Despite the huge numbers of people affected by lung cancer, lack of knowledge or awareness remains high. Vagueness of symptoms, symptom overlap, and disease misconceptions mean many people don’t seek help as soon as they could. This, coupled with the associated stigma and nihilistic perceptions that are intrinsically linked to lung cancer, are all contributing to later diagnosis.

In late 2022, we partnered with NHS England and toured the country with our giant inflatable lungs to raise awareness of lung cancer and start much-needed conversations around the disease.

Lung cancer is a disease that no one wants to talk about but, by being more open about a disease that affects so many of us, and helping to recognise the symptoms and encourage them to take immediate action, can save lives.

Standing 12ft high, the MegaLungs are a sight to behold and provide an ideal icebreaker to this taboo topic. Large enough for visitors to step inside, they can learn about typical lung structures, lung health and the effects of smoking.

Trained community engagement teams and patient advocates were then on hand to talk about suspected symptoms and encourage them to visit their GP or, for those encountering difficulties seeing a GP, to contact our Ask the Nurse helpline for advice and support.

We are now working to replicate this activity in our campaign for lung cancer awareness month 2023.

Work to do

Early detection has never been more imperative. Latest research has revealed a “universal” cure for cancer is “unlikely anytime soon”.

The study – entitled TracerX and funded predominately by Cancer Research UK – tracked lung cancers for nine years. It has provided the most in-depth analysis of how cancers evolve and what causes them to spread.

“It has surprised me how adaptable tumours can be,” Prof Swanton, lead researcher on TracerX, told the BBC Health and Science correspondent, James Gallagher.

“I don’t want to sound too depressing about this, but I think – given the almost infinite possibilities in which a tumour can evolve, and the very large number of cells in a late-stage tumour, which could be several hundred billion cells – then achieving cures in all patients with late-stage disease is a formidable task.

“If we want to make the biggest impact we need to focus on prevention, early detection and early detection of relapse.”

In short, the best way to stop lung cancer is to catch it at its earliest stage. And that’s what we intend to do.