Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge.
Wellcome Trust primary care doctoral fellow.
Br J Gen Pract. 2021 Mar 26;71(705):e273-e279. doi: 10.3399/bjgp20X714077. Print 2021 Apr.
National guidelines in England recommend prompt chest X-ray (within 14 days) in patients presenting in general practice with unexplained symptoms of possible lung cancer, including persistent cough, shortness of breath, or weight loss.
To examine time to chest X-ray in symptomatic patients in English general practice before lung cancer diagnosis, and explore demographical variation.
Retrospective cohort study using routinely collected general practice, cancer registry, and imaging data from England.
Patients with lung cancer who presented symptomatically in general practice in the year pre-diagnosis and who had a pre-diagnostic chest X-ray were included. Time from presentation to chest X-ray (presentation-test interval) was determined and intervals classified based on national guideline recommendations as concordant (≤14 days) or non-concordant (>14 days). Variation in intervals was examined by age, sex, smoking status, and deprivation.
In a cohort of 2102 patients with lung cancer, the median presentation-test interval was 49 (interquartile range [IQR] 5-172) days. Of these, 727 (35%) patients had presentation-test intervals of ≤14 days (median 1 [IQR 0-6] day) and 1375 (65%) had presentation-test intervals of >14 days (median 128 [IQR 52-231] days). Intervals were longer among patients who smoke (equivalent to 63% longer than non-smokers; <0.001), older patients (equivalent to 7% longer for every 10 years from age 27; = 0.013), and females (equivalent to 12% longer than males; = 0.016).
In symptomatic primary care patients who underwent chest X-ray before lung cancer diagnosis, only 35% were tested within the timeframe recommended by national guidelines. Patients who smoke, older patients, and females experienced longer intervals. These findings could help guide initiatives aimed at improving timely lung cancer diagnosis.
英格兰国家指南建议，在以持续性咳嗽、呼吸急促或体重减轻等不明原因的肺癌疑似症状就诊于普通科的患者中，应在 14 天内尽快进行胸部 X 光检查。
检查英格兰普通科就诊的有症状肺癌患者进行胸部 X 光检查的时间，并探讨人口统计学差异。
使用常规收集的普通科、癌症登记处和英格兰成像数据进行回顾性队列研究。
纳入在诊断前一年以症状就诊普通科且进行了诊断前胸部 X 光检查的肺癌患者。确定从就诊到胸部 X 光检查（就诊-检查间隔）的时间，并根据国家指南建议，将间隔分类为一致（≤14 天）或不一致（>14 天）。通过年龄、性别、吸烟状况和贫困程度来检查间隔的差异。
在 2102 名肺癌患者的队列中，就诊-检查间隔的中位数为 49（四分位距[IQR] 5-172）天。其中，727（35%）名患者的就诊-检查间隔为≤14 天（中位数 1[IQR 0-6]天），1375（65%）名患者的就诊-检查间隔>14 天（中位数 128[IQR 52-231]天）。与不吸烟者相比，吸烟者的间隔时间更长（相当于长 63%；<0.001），年龄较大的患者（相当于从 27 岁起每增加 10 年就增加 7%；<0.013）和女性（相当于比男性长 12%；<0.016）。
在接受肺癌诊断前进行胸部 X 光检查的有症状初级保健患者中，只有 35%的患者在国家指南推荐的时间范围内进行了检查。吸烟患者、年龄较大的患者和女性患者的间隔时间更长。这些发现可以帮助指导旨在提高及时诊断肺癌的举措。
