Author(s): Kennedy M.P.T.; Robson J.M.; Ashford-Turner V.; Rodger K.; Paramasivam E.; Callister M.E.J.; Cheyne L.; Darby M.; Johnstone A.; Bhartia B.; Karthik S.; Plant P.; Milton R.; Gill A.; Malhotra P.; Foster C.; Lovatt V.; Hewitt F.; Cresswell L.; Coupland V.H.; Luchtenborg M.; Jack R.H.; Moller H.
Source: Thorax; Jun 2018
Publication Date: Jun 2018
Publication Type(s): Article In Press
Available at Thorax – from BMJ Journals – NHS
Abstract:Background: Lung cancer outcomes in the UK are worse than in many other developed nations. Symptom awareness campaigns aim to diagnose patients at an earlier stage to improve cancer outcomes. Methods: An early diagnosis campaign for lung cancer commenced in Leeds, UK in 2011 comprising public and primary-care facing components. Rates of community referral for chest X-ray and lung cancer stage (TNM seventh edition) at presentation were collected from 2008 to 2015. Linear trends were assessed by ++2 test for trend in proportions. Headline figures are presented for the 3 years pre-campaign (2008-2010) and the three most recent years for which data are available during the campaign (2013-2015). Findings: Community-ordered chest X-ray rates per year increased from 18 909 in 2008-2010 to 34 194 in 2013-2015 (80.8% increase). A significant stage shift towards earlier stage lung cancer was seen ( ++2(1)=32.2, p<0.0001). There was an 8.8 percentage point increase in the proportion of patients diagnosed with stage I/II lung cancer (26.5% pre-campaign vs 35.3% during campaign) and a 9.3% reduction in the absolute number of patients diagnosed with stage III/IV disease (1254 pre-campaign vs 1137 during campaign). Interpretation: This is the largest described lung cancer stage-shift in association with a symptom awareness campaign. A causal link between the campaign and stage-shift cannot be proven but appears plausible. Limitations of the analysis include a lack of contemporary control population.
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