Is earlier identification of cancer patients feasible using symptoms alone: Implications for screening

This study evaluates the presenting symptoms of patients sent to a rapid access (RA)clinic to see if a particular symptom complex is associated with those patients who after investigations are found to have definite lung cancer. Patients attending the RA clinics in a 3-month period (n=112) were approached to participate in the study, informed consent was obtained from 103. GP records of these patients were studied retrospectively (85 available) and significant symptoms noted. Patients were interviewed at the time of presentation to ascertain their symptom complex and were followed prospectively until a final diagnosis was reached (cancer (CA) n=49, non-cancer (NCA) n=54). CA patients were significantly older (mean 65.8) than the NCA (mean 58.5 ). Age ranges and sex distribution were not significantly different between the groups. More of the CA group had ever smoked (90% vs 76% p=0.04) and had a significantly higher packyear exposure (CA mean 53.8 vs NCA mean 26.8 p<0.03). At the time of presentation there was no significant difference between the groups for the prevalence of symptoms of underlying malignancy There was no difference between the groups for the time from first symptoms which stimulated referral and seeing the Primary Care Physician (CA median 1.25mths, NCA median 1.5mths). From the GP records (with a median of 6 yrs available prior to referral (range 2 to 9yrs)) the NCA group interestingly had a significantly higher prevalence of documented symptoms. This study would suggest that patients present in the majority of cases in a very timely fashion following the development of a new symptom. It does not appear possible however to differentiate CA from NCA patients using prior and current symptomatology leaving some form of screening as the only option.