College of Medicine and Health, University of Exeter, Exeter.
Br J Gen Pract. 2020 Feb 27;70(692):e193-e199. doi: 10.3399/bjgp20X708137. Print 2020 Mar.
Most patients diagnosed with lung cancer present with symptoms. It is not known if the proportions of patients presenting with each symptom has changed over time. Identifying trends in lung cancer's presenting symptoms is important for medical education and early-diagnosis initiatives.
To identify the first reported symptom of possible lung cancer (index symptom), and to test whether the percentages of patients with each index symptom changed during 2000-2017.
This was a serial, cross-sectional, observational study using UK Clinical Practice Research Datalink (CPRD) data with cancer registry linkage.
The index symptom was identified for patients with an incident diagnosis of lung cancer in annual cohorts between 1 January 2000 and 31 December 2017. Searches were constrained to symptoms in National Institute for Health and Care Excellence (NICE) suspected-cancer referral guidelines, and to the year before diagnosis. Generalised linear models (with a binomial function) were used to test if the percentages of patients with each index symptom varied during 2000-2017.
The percentage of patients with an index symptom of cough (odds ratio [OR] 1.01; 95% confidence interval [CI] = 1.00 to 1.02 per year; <0.0001) or dyspnoea (OR 1.05; CI = 1.05 to 1.06 per year; <0.0001) increased. The percentages of patients with other index symptoms decreased, notably haemoptysis (OR 0.93; CI = 0.92 to 0.95; <0.0001) and appetite loss (OR 0.94; CI = 0.90 to 0.97; <0.0001).
During 2000-2017, the proportions of lung cancer patients with an index symptom of cough or dyspnoea increased, while the proportion of those with the index symptom haemoptysis decreased. This trend has implications for medical education and symptom awareness campaigns.
大多数被诊断为肺癌的患者都有症状。目前尚不清楚随着时间的推移，出现每种症状的患者比例是否发生了变化。确定肺癌首发症状的趋势对于医学教育和早期诊断计划非常重要。
确定可能肺癌的首发症状（首发症状），并检验 2000 年至 2017 年间，每位首发症状患者的百分比是否发生了变化。
这是一项使用英国临床实践研究数据链（CPRD）与癌症登记处链接的连续、横断面、观察性研究。
在 2000 年 1 月 1 日至 2017 年 12 月 31 日期间，对年度队列中患有肺癌的患者的首发症状进行了识别。搜索仅限于国家卫生与保健卓越研究所（NICE）可疑癌症转诊指南中的症状，且限制在诊断前一年。使用广义线性模型（二项式函数）检验 2000 年至 2017 年间，每位首发症状患者的百分比是否发生了变化。
以咳嗽（比值比 [OR] 1.01；95%置信区间 [CI] = 1.00 至 1.02/年；<0.0001）或呼吸困难（OR 1.05；CI = 1.05 至 1.06/年；<0.0001）为首发症状的患者比例增加。以咯血（OR 0.93；CI = 0.92 至 0.95；<0.0001）和食欲减退（OR 0.94；CI = 0.90 至 0.97；<0.0001）为首发症状的患者比例下降。
在 2000 年至 2017 年间，以咳嗽或呼吸困难为首发症状的肺癌患者比例增加，而以咯血为首发症状的患者比例下降。这一趋势对医学教育和症状意识运动具有重要意义。
