27th May 2022

Spot the Difference

View all Awareness

There are many different symptoms of lung cancer, and many different causes. But one thing remains the same… the sooner lung cancer is diagnosed, the easier it is to treat.

This was the focus of our latest awareness campaign, Spot the Difference, helping people spot any differences in their health – no matter how subtle – and encourage them to take immediate action.

Working for the NHS, Tracy always tells her patients to give her the full story of their illness so when she had a second chest infection in the space of just a few months, Tracy made sure she told her GP about both.

“Something just sort of clicked with him. He asked if I was normally fit and healthy which I am. Like everyone I have the odd cough and cold, but I usually shake it off quite quickly, so this was unusual for me. That was when he said he would like to send me for an x-ray.”

This immediate action made all the difference; Tracy went on to diagnosed with early-stage lung cancer. A month after surgery, she went on holiday to Fuerteventura!

I came out of hospital on the 21st May and was due to go on holiday on the 26th June. I spoke to my consultant, and he was confident I would be ok to go so a month after having part of my lung removed, I went on holiday! I obviously took things easy, but it was just wonderful. I then went back to work in October and now, life is totally back to normal.

I am just so grateful for the experience I had, that the GP spotted that these chest infections were unusual for me and sent me for that x-ray. But I’m also relieved that I made sure I told him the full picture. If I hadn’t mentioned the previous chest infection, if I had just dismissed it or thought it wasn’t relevant, then things might have been very different.”

Not always so simple

Sadly, Tracy’s case is not all that typical. Often vague in nature, lung cancer symptoms are easily dismissed as something else – by both the patient and healthcare professionals, and even more so since Covid.

Nick was seeing his doctor for 18-24 months with several symptoms, including a persistent cough.

Under the guidance from the National Institute of Health and Care Excellence (NICE), he should have been referred for an urgent chest x-ray. Instead, Nick’s lung cancer went undetected until he eventually coughed up blood.

“I constantly mentioned my cough to my doctor, but I was repeatedly told that I didn’t need to worry because it was just ‘a smoker’s cough’. So even when the cough got worse, I wasn’t that concerned. I was still smoking so it made sense.

However, whilst I was working away, I coughed up some blood. That’s when I did start to worry. I went to A&E, and this was the start of my diagnosis.”

Fortunately, Nick was still diagnosed early enough for curative-intent treatment, undergoing both surgery and chemotherapy. He has even been able to return to scuba diving. However, it could have been a very different story, one Nick is keen to avoid others falling foul of.

“Looking back on my diagnosis, I can see that there were many missed opportunities. I think one of the reasons I wasn’t sent for an x-ray earlier was because of how fit I was. As a scuba diver, my lung capacity is good, so I wasn’t having any shortness of breath. I wasn’t tired and I wasn’t losing weight and I think that’s it was just put down to just a smoker’s cough.

I don’t lay any blame. I accept that a GP can’t be expected to know every symptom for every illness. But I do wish I had been referred sooner than I was, and I just hope that campaigns like Spot the Difference can educate GPs and help them see a little bit earlier that it’s time to start referring this person to somebody more specialised, or at least to get an x-ray.”

Nick’s story was featured in the campaign’s primary care toolkit and distributed to GPs across the country. Dr Afsana Bhuiya, GP Cancer Lead for the North Central London Cancer Alliance, described the toolkit as ‘really helpful’, while Charlotte Beames from C the Signs, a multiple platform digital tool to help GPs identify patients at risk of cancer at the earliest and most curable stage of the disease, too found it ‘fantastic resource for GPs’.

The doctor will see you now?

However, there remained another consequence of the pandemic; the ability to see a doctor face-to-face became a real challenge. So, when met with the advice to contact their GP if they were experiencing symptoms, many scoffed at even the prospect.

“I think the first thing is to be persistent,” advises Carol Stonham, primary care nurse and executive chair of the Primary Care respiratory society.

“It’s very easy to request an appointment and be brushed off and feel that’s the end of it. It absolutely must not be the end of it. It’s up to you as the patient to make sure the person you are talking to realises what the problems are, that they are persistent and ongoing and should not brushed off.

“Saying the words ‘I think I might have cancer’ are really hard, but if that’s what you think is happening, it’s really important that you tell something that’s what your fear is. Then you’ll be taken more seriously.”

When it comes to lung cancer, there are so many differences – from the symptoms experienced to the speed of diagnosis, the treatment received and ultimately, the tragically different outcomes. Tracy’s story was as straightforward as they come. Nick’s was far from perfect. But thankfully, they both had a same happy ending.

And it’s our hope that campaigns like Spot the Difference, which help raise awareness and validate even the most subtle of symptoms, will continue to make a difference so more people will have the same, positive outcome as Nick and Tracy.

You can be the difference

Ultimately, the key is persistence. If your symptoms are persistent, you need to be too.

Insist on seeing doctor. Be polite but be persistent, and when you do have an appointment, be prepared. Make notes of all your symptoms and concerns before your appointment so you can give the doctor the full picture.

Chase up appointments and test results. Don’t just wait for them to call.

If you have had a course of antibiotics and they haven’t work, don’t just accept another round. Explain that they haven’t helped and ask if there is anything else you can try or if it needs to be investigated further. This is what can make all the difference.