Roy Castle Lung Cancer Foundation is committed to improving the early detection of everyone affected by lung cancer.
The introduction of lung cancer screening is the biggest step forward in improving early diagnosis. However, with more than half of lung cancers arising in people who aren’t eligible for screening and only around half of those who are eligible choosing to participate, improving early detection amongst those with symptoms is key to transforming long-term survival.
In March 2023, we hosted a workshop to identify ways to improve the early diagnosis of lung cancer in symptomatic patients. We have now had the paper with our recommendations published in the British Journal of General Practice in December 2024.
Executive Summary
The existing evidence identifies four key objectives for improving early diagnosis of symptomatic lung cancer:
- To develop improved processes that result in earlier diagnosis of symptomatic lung cancer
- To increase awareness of symptoms and motivation for appropriate help-seeking in the general public
- To ensure better access to diagnostic tests and assessment
- To equitably and sustainably increase the number of diagnostic tests (chest X-ray and CT) in people with symptoms that may represent lung cancer
Multiple barriers exist to achieving these objectives both for patients with the common symptoms of lung cancer and the healthcare system. These relate to awareness of symptoms that may indicate lung cancer, lack of prompt and easy access to healthcare assessment and underuse of imaging in those at risk.
Specific issues are:
- Lack of awareness about the common symptoms of lung cancer
- Inconsistent understanding by patients and clinicians that patients in apparently low risk groups such as never smokers (where risk if poorly understood), can get lung cancer and constitute a substantial proportion of cases
- Public and patient fears over being dismissed, judged, or criticised for misuse of the healthcare service
- Patient worry that symptoms are not worthy of investigation
- Lack of easy access by patients and carers to healthcare assessment
- Attribution of common symptoms of lung cancer to common respiratory illnesses,
- such as respiratory tract infection
- Lack of primary care access to timely CXR and reporto Variation in the threshold of primary care clinicians to investigate the common
- symptoms of lung cancer
- False reassurance following a normal CXR
- Lack of robust safety netting after a normal CXR
- Lack of clear guidance on which patients require further investigation following a normal CXR
Potential solutions to these challenges include:
- Public education & symptom awareness campaigns
- Engagement with primary care clinicians to support timely investigation
- Alternative routes to CXR and/or CT for people with the common symptoms of lung cancer including self-referral CXR and a cancer symptom concern hotline
- Training and support for non-medically qualified clinicians in primary care to request CXRs
- Publishing CXR rates by GP practice and administrative units (e.g. Primary Care Networks and Integrated Care Systems)
- Digital clinical decision support tools for general practice
- Proactive safety netting systems following a normal CXR (e.g. telephone call, text message or follow up actions guided by clinical algorithms
- Specific guidance for which patients to refer on the suspected lung cancer pathway or for CT imaging following a normal CXR
- GP direct access to CT for patients with a suspicion of lung cancer following a normal CXR.
Our calls have since been picked up several media publications:
- The Independent: Make it easier for those with lung cancer symptoms to get tests, experts say
- The Times: Let more people with lung cancer symptoms self refer for x-rays
- ITV News: People with lung cancer symptoms should be able to self-refer for tests, experts claim
- The Guardian: Allow more people in UK with lung cancer symptoms to self-refer for tests, say experts