Background: General practitioners are integral to the early detection of lung cancer, as most patients with lung cancer first present to primary care settings, often seeing a GP ?4 times before a diagnosis is made.1,2 Cancer Australia developed Investigating symptoms of lung cancer: a guide for all health professionals (the Guide) to provide a systematic approach to investigating unexplained, persistent symptoms and signs that may be due to lung cancer.
Method: Cancer Australia used an evidence-based, systematic methodology to develop the Guide: 1. convening a multidisciplinary Expert Reference Group co-chaired by a GP reviewing current national and international clinical practice guidelines undertaking targeted systematic reviews consulting with clinical colleges and consumer bodies, and focus testing with GPs.
Results: The Guide and its supporting Evidence Report includes information on lung cancer risk factors; different population groups; symptoms and signs of lung cancer; imaging modalities; optimal timeframes for investigation and referral; and the importance of multidisciplinary care. The Guide is a Royal Australian College of General Practitioners Accepted Clinical Resource, and is endorsed by 11 organisations.
Discussion: Lung cancer is the leading cause of cancer burden and cancer death in Australia.3 Early diagnosis and treatment lead to improved survival, however, non-specific symptoms and smoking-related stigma may delay diagnosis.4,5,6 Additionally, during the COVID-19 pandemic, it is important to consider respiratory symptoms as presentation of lung cancer not COVID-19. GPs need to be alert to the key steps and optimal timeframes for investigating this disease, to support rapid referral of patients into the multidisciplinary diagnostic pathway. The Guide provides opportunities for practice improvement through audits of investigation modalities and timeframes for investigation and referral.
Implications for practice: Access to up-to-date evidence on best-practice lung cancer care is critical for improving outcomes for lung cancer patients. Widespread adoption of the Guide among GPs will support this quest. References 1. Emery JD. The challenges of early diagnosis of cancer in general practice. The Medical journal of Australia. 2015;203(10):391-3. 2. Purdie S, Creighton N, White KM, et al. Pathways to diagnosis of non-small cell lung cancer: a descriptive cohort study. NPJ Prim Care Respir M. 2019;29(1):2. 3. Australian Institute of Health and Welfare. Cancer in Australia 2019. Cancer series no.119. Cat. no. CAN 123. Accessed April 2020; https://www.aihw.gov.au/reports/cancer/cancer-in-australia-2019/contents/table-of-contents 4. Cassim S, Chepulis L, Keenan R, et al. Patient and carer perceived barriers to early presentation and diagnosis of lung cancer: a systematic review. BMC cancer. 2019;19(1):25. 5. Weller DP, Peake MD and Field JK. Presentation of lung cancer in primary care. NPJ primary care respiratory medicine. 2019;29(1):21. 6. Bradley SH, Kennedy MPT and Neal RD. Recognising Lung Cancer in Primary Care. Advances in therapy. 2019;36(1):19-30