Abstract Background: 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. Aim: To examine time to chest X-ray in symptomatic patients in English General Practice prior to lung cancer diagnosis and explore variation by demographics. Design and Setting: Retrospective cohort study using routinely collected General Practice, cancer registry and imaging data from England. Method: Patients with lung cancer who presented symptomatically in General Practice in the year pre-diagnosis and 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. Results: In a cohort of 2102 lung cancer patients, the median presentation-test interval was 49 days (interquartile range, IQR:5-172). 727 (35%) patients had presentation-test intervals of <14 days (median:1 day; IQR:0-6) and 1375 (65%) had presentation-test intervals of >14 days (median:128 days; IQR:52-231). Intervals were longer among smokers than non-smokers (63% longer; p<0.001), older patients (7% longer for every 10-years; p=0.013) and females (12% longer than males; p=0.016). Conclusion: 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. Smokers, older patients and females experienced longer intervals. These findings could help guide initiatives aimed at improving timely lung cancer diagnosis.
A feasibility study examining the effect on lung cancer diagnosis of offering a chest X-ray to higher-risk patients with chest symptoms: protocol for a randomized controlled trial