Nearly one in three patients with lung cancer in the United Kingdom die within 3 months of diagnosis, despite consulting their primary care physicians more frequently than patients who survived longer, according to study findings.
Prior studies have shown that the United Kingdom has poor lung cancer survival rates compared with other countries, due in part to late diagnosis and consequent high early mortality from lung cancer.
Researchers utilized data from The Health Improvement Network to isolate 20,142 cases of lung cancer documented from 2000 to 2013 and calculate the percentage of early deaths based on dates of diagnosis and death.
Early death was defined as death within 90 days of diagnosis. Patients who survived longer than 90 days served as the reference group. The researchers adjusted for covariates, including age, gender, smoking status, Charlson comorbidity index score, Townsend index of deprivation score, social isolation and rural vs. urban residence.
The researchers also analyzed records of primary care consultations between 0 and 4 months before lung cancer diagnosis. Patients were categorized as low (0-5 consultations) medium (6-10) and high frequency consulters (more than 10 consultations). Additionally, the researchers reported all pre-diagnosis requests for chest X-rays.
The researchers found that of 20,142 lung cancer cases, those who died visited their primary care doctors more frequently before diagnosis than control cases. Covariates associated with early death included the following: male gender (OR=1.17; 95% CI, 1.1-1.24), current smoker (OR=1.43; 95% CI, 1.28-1.61), older than 80 years (OR=1.8; 95% CI, 1.62-1.99 vs. aged 65-69 years), lower socioeconomic status (OR=1.16; 95% CI, 1.04-1.3 for Townsend quintile 5 vs. quintile 1) and rural residence (OR=1.22; 95% CI, 1.06-1.41 vs. urban residence).
The rates of chest X-ray request were widely divergent across primary care practices, with the practices that requested more chest X-rays having the highest odds of early death.
According to the researchers, the average primary care physician will likely see only one new case of lung cancer in a given year.
“For this reason we need to promote better use of risk assessment tools, and use software prompts to help general practitioners to identify and investigate in a timely manner those at risk,” the researchers wrote. “This has potential to increase the proportion of patients who are diagnosed at an early stage and are, therefore, suitable for treatment with curative intent.”
Disclosure: Please see the full study for a list of relevant disclosures.