Does raising awareness of lung cancer symptoms in primary care alter referral patterns

Background: Patients with lung cancer often present late with advanced disease. This results from both symptomatic patients not presenting to primary care and delayed referral following presentation. Aim: To examine whether sending General Practitioners (GPs) a reminder of the “red light” symptoms of lung cancer would increase urgent referrals and lead to earlier diagnosis. Method: All 67 sugeries in South East Essex PCT received a postal reminder of the referral criteria for lung cancer. All suspected cancer referrals to Chest Clinic for 10 weeks before and after this were audited retrospectively and each case followed to completion on the pathway. Results: 121 patients were referred over 20 weeks. The total number of referrals increased post intervention from 57 to 64 (12%) though this was not statistically significant (p=0.6). There was a statistically significant increase in referrals in the first 3 weeks post intervention (p=0.046) but this effect was lost by week 4 (p>0.2). More patients were discharged from the pathway in the post intervention group (28.1% vs 24.6%, p>0.2) and fewer diagnosed with cancer (26.6% vs 28.1%, p>0.2). Referrals due to haemoptysis increased in the post intervention group (10% vs 5.2%) but this did not reach significance (p=0.06). Conclusion: Sending out referral guidelines resulted in an initial increase in referral numbers. This effect was lost after 3 weeks and did not improve cancer detection rates however numbers in this study were small. This suggests that resources need to be focussed on increasing patient as well as GP awareness if outcomes are to improve.