Early diagnosis pivotal to survival in lung cancer

The UK has been highlighted, by the International Cancer Benchmarking Project and the EUROCARE groups, as a country with one of the lowest lung cancer survival rates. It has been postulated that this is due to an excess of early deaths, delays in diagnosis are thought to contribute to this problem. A recent study showed that 30% of patients with lung cancer die within the first 90 days and they have seen their GP on average five times in the four months before diagnosis, suggesting there may be opportunities to diagnose these patients earlier in the disease process. The challenge GPs face is to identify and refer those at risk as early as possible and to maintain a high index of suspicion if symptoms persist. The SIGN guideline reiterates the importance of performing a chest X-ray in those in whom the suspicion of lung cancer has been raised and not to be falsely reassured by a normal chest X-ray in a high-risk patient. The initial investigation of choice in secondary care remains a CT scan of the chest and abdomen, followed by PET-CT scanning in those deemed suitable for potentially curative treatment. Smoking cessation reduces the risk of post-operative and systemic treatment-related complications and also reduces the chance of cancer recurrence. Surgery remains the initial treatment of choice for those with early stage disease in NSCLC who are deemed fit enough. Those who have early stage NSCLC (stage I or stage II) who are either medically inoperable or decline surgery should be offered radical radiotherapy. Hospital follow-up should be continued while patients are receiving treatment, complemented by clinical nurse specialist input alongside community support. All patients should have access to specialist palliative care teams. Those with palliative care input have improved quality of life and symptom control and fewer hospitalisations.