Primary Care toolkit

As part of the Spot the Difference campaign, we have created a number of tools and resources for primary care to help identify potential lung cancer cases as soon as possible.

Resources include:

  • Primary care referral guidelines
  • Symptoms tracker for patients
  • Lung cancer signs and symptoms video
  • How to differentiate lung cancer from Covid-19 infographic
  • Patient case studies
  • Safety netting and re-consultation for lung cancer symptoms research video
  • Lung health checks
  • Smoking cessation.

Primary care referral guidelines

NICE guidelines

A patient should be referred for an urgent chest x-ray if they are over 40 and have two or more of the following symptoms, or have one symptoms and have ever smoked.

  • Cough
  • Fatigue
  • Shortness of breath
  • Chest pain
  • Weight loss
  • Appetite loss.

An urgent chest X-ray should also be considered to assess for lung cancer in people aged 40 years and over with any of the following symptoms:

  • Persistent or recurrent chest infection
  • Finger clubbing
  • Chest signs consistent with lung cancer
  • Supraclavicular lymphadenopathy or persistent cervical lymphadenopathy
  • Thrombocytosis.

SIGN guidelines

Urgent suspicion of cancer chest X-ray (CXR)

  • Any unexplained haemoptysis
  • Unexplained and persistent (more than three weeks)
    • change in cough or new cough
    • dyspnoea
    • chest/shoulder pain
    • loss of appetite
    • weight loss
    • chest signs
    • hoarseness (if no other symptoms present to suggest lung cancer refer via Head & Neck pathway)
    • fatigue in a smoker aged over 40 years.
  • New or not previously documented finger clubbing
  • Persistent or recurrent chest infection
  • Cervical and/or persistent supraclavicular lymphadenopathy (if CXR normal, refer via Head and Neck pathway)
  • Thrombocytosis where symptoms and signs do not suggest other specific cancer (if CXR normal, consider alternative diagnosis including other cancer)
  • Any person who has consolidation on chest X-ray should have further imaging no more than six weeks later to confirm resolution.

Symptom tracker for patients

Our free symptom tracker allows patients to monitor their symptoms and allow them to present a fuller, more detailed picture of the problem.

Signs and symptoms video

There are many different symptoms of lung cancer. They are often vague and can be attributed to many other conditions. Our infographic and video provide a simple guide to the different types of symptoms.

Differentiating lung cancer and Covid infographic

One of the contributing factors of the decline in lung cancer referral rates is due to the similarities in symptoms with Covid-19.

The following infographic has been produced by the Lung Cancer Clinical Expert Group to help healthcare professionals spot the differences between lung cancer and Covid-19.

Patient case studies

Lung cancer is a disease which can affect anyone. These two very different case studies are designed to act as a useful tool should you see a similar patient. We appreciate the majority of patients like Nick and Joanna won’t have lung cancer but if you see a patient with similar symptoms, it is refer for x-ray.

Nick, 54

Nick repeatedly went to his GP with a cough and back pain for nearly two years. He was told it was a ‘smoker’s cough’ and given painkillers for his back. He then coughed up blood and went to A&E where he went on to be diagnosed with stage 3b lung cancer but was able to have curative-intent surgery and chemo.

Joanna, 33

Joanna had many different symptoms, including breathlessness, an intermittent cough, recurring chest infections and shoulder pain. She also lost 2st in weight whilst she was pregnant. She went to her GP many times over a 14-month period before her eventual diagnosis of incurable ALK-positive lung cancer.

Safety netting and re-consultation for lung cancer symptoms research video

From the first noticed symptoms, it takes longer to reach a diagnosis for lung cancer than for many of the other majority cancer types. This fact greatly contributes to poorer survival rates among lung cancer patients.

A Roy Castle Lung Cancer Foundation funded research project aims to identify the current strategies of “safety netting” implemented and the unintended negative effects in general practice with regard to patients who present with common lung cancer symptoms with low predictive value.

Lung health checks

Targeted lung health checks are now back up and running in selected sites across England.

If there is a lung health check programme in your area, please encourage patients to attend if they are eligible to do so.

Lung health checks are available to people:

  • Aged 55-74
  • Current and former smokers.

Smoking Cessation

If you spot a patient who is still smoking, please do what you can to encourage them to stop smoking. We appreciate many smoking cessation services are no longer available, or have endured cut backs. We run a free online stop smoking forum called Quit Support. Users share their experiences, ask questions and benefit from support from people who know exactly what they are going through.

Additional lung cancer primary care educational tools are  on the GatewayC website.