Changes in the presenting symptoms of lung cancer from 2000–2017: a serial cross-sectional study of observational records in UK primary care

Abstract

Background Most patients diagnosed with lung cancer present with symptoms. It is not known if the proportions of patients with each presenting symptom has changed over time. Identifying trends in lung cancer’s presenting symptoms is important for medical education and earlydiagnosis initiatives. Aims To identify the first reported symptom of possible lung cancer (index symptom). To test whether the percentages of patients with each index symptom changed during 2000–2017. Design and Setting This was a serial, cross-sectional, observational study using UK Clinical Practice Research Datalink (CPRD) data with Cancer Registry linkage. Methods We identified the index symptom for patients with an incident diagnosis of lung cancer in annual cohorts between 01/01/2000 and 31/12/2017. Searches were constrained to symptoms in National Institute for Care Excellence suspected-cancer referral guidelines, and to the year before diagnosis. We used generalised linear models (with a binomial function) to test if the percentages of patients with each index symptom varied during 2000–2017. Results The percentage of patients with an index symptom of cough (odds ratio per year (OR) 1.01, 95% confidence interval (CI) 1.00-1.02 per year) or dyspnoea (1.05, 1.05-1.06 per year) increased. The percentages of patients with other index symptoms decreased, notably haemoptysis (0.93, 0.92-0.95) and appetite loss (0.94, 0.90-0.97) (all p<0.0001). Conclusion During 2000–2017, the proportions of lung cancer patients with an index symptom of cough or dyspnoea increased, whilst haemoptysis decreased. This trend has implications for medical education and symptom awareness campaigns.