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Pathways to the diagnosis of lung cancer in the UK: a cohort study

DOI: 10.1186/1471-2296-9-31

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Three main routes to diagnosis emerged. The first was the expected route of outpatient referral; 150 (61% of the cohort) of patients took this route, although only 110 (45% of the whole cohort, 73% of those referred to outpatients) were referred to a respiratory department. 56 (23%) were admitted as an emergency, having previously described a lung cancer symptom to their doctor. 26 patients (11%) had no symptom of lung cancer reported before their diagnosis. The interval from first symptom to referral was similar across the different pathways. However, the referral to diagnosis interval was longer in patients misdirected to other outpatient departments (66 days, interquartile range 37,110) than those sent to respiratory clinics (29 days, 17,61) or admitted as an emergency (16 days 8,40); p < 0.001.Only a minority of lung cancer patients follow the traditional route to diagnosis. Clinical and research efforts need to consider the alternative routes if they are to maximise their impact on speed of diagnosis.Over 37,000 new lung cancers are diagnosed each year in the UK [1]. Mortality is very high, with lung cancer the leading cause of cancer deaths in the UK [1]. The poor survival reflects the intrinsically aggressive nature of the tumour, with the shortest doubling time of the common cancers, plus the fact that symptoms occur relatively late in the growth of the cancer [2]. Many patients also delay presenting their symptoms to their doctor, and the duration of symptoms is now recognised to be longer than previously thought [3,4]. Thus few patients are diagnosed at a stage when they could be offered curative surgery [5]. Furthermore, no screening test has been found to be effective, and none is near to implementation, though trials are in progress using spiral CT [5]. Most lung cancers present with symptoms, and in the UK, most of these patients present initially to their general practitioner (GP) [6].Unlike for most other common cancers, there exists a primary care i


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