Early diagnosis of lung cancer significantly improves patient outcomes. In primary care settings, chest X-rays are a crucial initial diagnostic tool for patients presenting with symptoms suggestive of lung cancer, such as persistent cough, shortness of breath, or unexplained weight loss. National guidelines, like those in England, emphasize the importance of prompt chest X-rays for such patients, recommending they be performed within 14 days of symptom presentation. However, real-world practice may deviate from these guidelines, potentially impacting timely diagnosis.
A recent study investigated the time intervals between symptomatic presentation in general practice and chest X-ray examination in patients who were subsequently diagnosed with lung cancer. This retrospective cohort study, utilizing data from English general practices, cancer registries, and imaging records, aimed to evaluate adherence to the 14-day guideline and explore demographic factors influencing these time intervals. The research focused on patients with lung cancer who exhibited symptoms in primary care within the year before their diagnosis and underwent a chest X-ray prior to diagnosis.
The study meticulously analyzed the “presentation-test interval,” defined as the time from symptom presentation to the chest X-ray. These intervals were then categorized as either guideline-concordant (≤14 days) or non-concordant (>14 days). Researchers further examined how these intervals varied across different patient demographics, including age, sex, smoking status, and socioeconomic deprivation levels.
The findings revealed a concerning picture regarding the timeliness of chest X-rays in primary care diagnosis for lung cancer. Among the cohort of 2102 lung cancer patients, the median presentation-test interval was found to be 49 days, with a wide interquartile range (IQR 5-172 days), indicating significant variability. Alarmingly, only 35% of patients received a chest X-ray within the guideline-recommended timeframe of 14 days. These patients experienced a median interval of just 1 day (IQR 0-6 days), highlighting efficient processing for some. However, the majority, 65% of patients, faced non-concordant intervals exceeding 14 days, with a considerably longer median interval of 128 days (IQR 52-231 days).
Further analysis uncovered disparities in these intervals across demographic groups. Patients who were smokers experienced significantly longer delays in receiving a chest X-ray, with intervals estimated to be 63% longer compared to non-smokers (P<0.001). Older patients also faced delays, with intervals increasing by approximately 7% for every 10 years of age from 27 years old (P = 0.013). Additionally, female patients experienced 12% longer intervals compared to their male counterparts (P = 0.016).
These results underscore a significant gap between national guidelines and actual practice in primary care diagnosis of lung cancer using chest X-rays. The fact that only a third of symptomatic patients received timely chest X-rays suggests potential delays in diagnosis for a substantial proportion of lung cancer cases. The identified demographic variations, particularly the longer intervals for smokers, older patients, and females, point towards potential areas for targeted interventions to improve diagnostic pathways. Addressing these delays and ensuring more timely access to primary care diagnosis x-rays is crucial for improving lung cancer outcomes and aligns with the goal of earlier cancer detection. These findings provide valuable insights for developing and implementing initiatives aimed at enhancing the efficiency and equity of lung cancer diagnostic processes in primary care.
