Lung cancer: late diagnosis and inequitable treatment after ED presentation

Lung cancer

By Michael Woodhead

1 Aug 2018

One in three patients with lung cancer is diagnosed after an emergency department presentation despite multiple preceding visits to a GP, a study from NSW has shown.

Highlighting the difficulties and delays in diagnosis of lung cancer, a review of care patterns for 647 patients with non-small cell lung cancer also found that people without private health cover were less likely than insured patients to receive anti-cancer treatment.

The analysis by researchers from Cancer Council NSW is based on data from hospital and healthcare databases including Medicare and PBS, covering the period 2006-2010.

It found that emergency presentations accounted for 34.5% of cases of NSCLC, and these patients were more likely to be diagnosed with advanced disease. The vast majority (92%) had visited a GP more than three times in the six months prior to diagnosis of NSCLC.

At diagnosis, 22% of cases had localised disease, 20% had regional spread and 39% had distant metastases, whereas 19% had unknown spread of disease recorded.

Emergency department presentation was also associated with being a recent ex-smoker (having quit within the last 15 years) and there was a trend for patients to be older and less educated than those diagnosed in other settings.

Around 70% of patients with NSCLC received anti-cancer treatment following their diagnosis, with the type of treatment varying considerably depending on the stage of disease.

However the authors of the study published in Lung Cancer noted that 30% of patients received no anti-cancer treatment, including 20% with localised disease.

Factors associated with not receiving treatment included older age and not having private health insurance. Patients without private health insurance also faced significantly longer waiting times for treatment than those with insurance  (2.2 months vs 1.4 months).

The researchers said the findings reflected the challenges of diagnosing a disease with non-specific symptoms and which often occurred in patients with co-morbidities such as COPD. They pointed to other interventions that are currently being developed and trialled to improve early detection of lung cancer such as risk assessment tools for smokers and ex-smokers.

“Other early detection interventions include the CHEST intervention that facilitates early presentation with symptoms in primary care and a referral decision prompt that supports GPs to provide early referral of people with a suspicious lesion to specialist respiratory care.”

“Future research should address opportunities to diagnose lung cancer earlier and to optimise treatment pathways,” they concluded.

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