Key Point

Patients often experience noticeable changes in their health long before they see their physicians and receive a diagnosis of lung cancer.

SOUTHAMPTON, UK—Late diagnosis of lung cancer obviously has a negative impact on patient outcomes. Although the literature has previously focused on delayed diagnosis due to practitioner or health system issues, delays in diagnosis can also occur because patients do not recognize their symptoms as serious and thus do not seek medical treatment.

Physicians also may not recognize these symptoms because they have no clear guide for differentiating patients who might have lung cancer from those presenting with symptoms of a minor illness.

“Although symptoms of lung cancer at diagnosis are well known, the interrelationship between symptoms and different types and stages of lung cancer is not, nor is there information about how these [symptoms] arise or how patients respond to them before diagnosis,” observed a group of researchers in the United Kingdom who interviewed patients with recently diagnosed lung cancer, asking about their symptoms before diagnosis and what prompted them to see their physicians.¹

Many of the respondents were able to recall symptoms that turned out to be cancer related but that the patients had not recognized as connected with the disease.

Twenty-two patients with recently diagnosed lung cancer were interviewed within three months of their diagnosis (20 were interviewed in the first month). Patients were asked to recall the date, week, or month that a symptom or change in health occurred and the actions that were taken.

The key events that were analyzed included:

SYMPTOMS NOT SEEN AS SERIOUS

Symptoms were similar among patients awaiting surgery and those with inoperable disease. Chest symptoms such as cough and changes in breathing were the most common, occurring in 15 patients, and chest or rib pain was experienced by more than half. Fourteen patients reported fatigue, lethargy, or weakness, and more than half (including four of the seven patients with operable disease) reported inexplicable weight loss—considered a symptom of advanced disease. Despite their actual duration, all symptoms were reported as new in the months preceding diagnosis. According to the interviews, patients frequently did not act in response to their new symptoms, even though such symptoms were marked.

In most cases, patients recalled a single symptom that finally resulted in their consulting their general practitioner, even though they may have had several other symptoms concurrently. Symptoms were recalled as having started four months to two years prior to diagnosis. A median of seven months elapsed between the first change in health status and the event that prompted patients to visit their physicians. This event occurred between two weeks and eight months prior to diagnosis. Once they visited their physicians, the process of referral for diagnostic investigation was fairly rapid. However, some patients could recall having their symptoms for more than a year—without seeing a physician.

Changes in health were not perceived by patients as a sign of illness. This was considered only after symptoms became severe. Breathing changes, cough, chest pain, weight loss, and fatigue were attributed to aging or were not considered serious by the patients; certainly, they were not considered symptoms of lung cancer.

Most patients had little or no contact with their physicians in the period between the first change in health status and the trigger resulting in a diagnosis. In fact, one patient had not seen a doctor for 30 years.

According to the authors, the viewpoint that lung cancer is generally asymptomatic until it is far advanced may not be true, because patients recalled having symptoms for months before lung cancer was diagnosed.

They also pointed out that understanding how patients respond to changes in their health could be useful in developing preventive strategies and better public education—especially for groups at high risk, such as smokers—about the key symptoms of lung cancer. “If successful,” they added, “this might lead to earlier presentation, faster diagnosis, and better outcomes.”

—Gale Jurasek

Reference
1. Corner J, Hopkinson J, Fitzsimmons D, et al. Is late diagnosis of lung cancer inevitable? Interview study of patients’ recollection of symptoms before diagnosis. Thorax. 2005;60:314-319.

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