‘It can be quite insidious’: Identifying lung cancer

Anastasia Tsirtsakis

7/09/2021 2:10:39 PM

New resources have been designed to help GPs notice the signs of lung cancer, which can be notoriously difficult to diagnose in general practice.

A man sitting on the couch coughing.
By the time the majority of Australians who have lung cancer are diagnosed, it has already advanced to stage four.

Lung cancer is Australia’s leading cause of cancer-related death.
But even though early diagnosis can significantly impact survival outcomes, more than half (53%) of all cases in Australia are diagnosed at stage four, at which point life expectancy is just 19% after 12 months.
Dr Kerry Hancock, Chair of RACGP Specific Interests Respiratory Medicine and a member of Cancer Australia’s Lung Cancer Advisory Group, told newsGP there can be challenges on the path to diagnosis due to non-specific symptoms, such as cough and chest pain. Some patients may also not develop symptoms until the cancer is advanced.
‘Some of the consumer feedback and research being done is that patients say, “I went to my doctor so many times with these symptoms and eventually I got diagnosed with lung cancer”,’ Dr Hancock said.
‘But it can be quite hard for GPs to make the diagnosis early because lung cancer can present in so many different ways, and it can be quite insidious.’
To encourage GPs to keep lung cancer front of mind when presented with risk factors, symptoms and signs consistent with the disease, Dr Hancock is facilitating a one-hour Q&A webinar on Thursday 9 September.
Hosted by Lung Foundation Australia and Cancer Australia, Investigating Symptoms of Lung Cancer: What’s the evidence? will feature a multi-disciplinary panel of lung cancer experts who will review the latest evidence and clinical recommendations.
‘What we want to highlight is that sometimes there will be symptoms there that GPs can act on,’ Dr Hancock said.
‘Or to wonder: Is this a patient who’s got risk factors for lung cancer? Should I be arranging investigations sooner rather than later?’
GPs who attend the webinar will also receive early access to accredited, scenario-based eLearning modules A Systematic Approach to Investigating Symptoms of Lung Cancer.
The free training is designed to assist GPs in applying the recommendations of Investigating symptoms of lung cancer: A guide for health professionals, which was updated last year.
Dr Hancock, who helped develop both the guide and online training, says fellow GPs are sure to find it ‘incredibly informative and enlightening’.
‘We’ve tried to make it as engaging as we can with case studies across different scenarios and across different populations, whether it be for Indigenous or inner city versus regional and rural,’ she said.
‘It will make you think, “If I have a patient who has had a persistent cough for three weeks … maybe I should be organising an initial investigation such as a chest x-ray and arranging for them to come back, reviewing them in another 3–4 weeks’ time and if they’ve still got a persistent cough, then doing some further investigations”.
‘And all the information is backed up by the guide. We want them to refer to that and use it, almost like a clinical algorithm.’
When investigating a patient’s symptoms, Dr Hancock says putting them into context with their risk factors is vital, but is concerned that a lot of the emphasis is often placed on those who spoke tobacco.
‘A significant amount of lung cancer is in non-smokers,’ she said.
‘That’s often where we don’t think about it because we have that nihilistic attitude that it must only happen in smokers and that this is a lifelong non-smoker, therefore, lung cancer is not going to be on the radar.
‘Or somebody who gave up smoking maybe 10 years ago, and you think of them as being essentially a non-smoker, when in fact their risk is still high. Or somebody who’s had some occupational exposure in the past to asbestos or noxious agents, which increases their risk of lung cancer.’
While education can certainly help ensure the possibility of lung cancer is front and centre for GPs, Dr Hancock says even for clinicians like herself who are respiratory interested, it can be a challenge.
‘It’s top of mind for me all the time, but certainly when I’ve looked at the last few cases of lung cancer that we have diagnosed in our practice, I actually think there is absolutely no way that a couple of them could have been diagnosed any earlier,’ she said.  
‘And even though they were stage four when they were diagnosed, it’s a bit like ovarian cancer, it just presents so insidiously that patients are not getting symptoms until it is actually at a late stage.’
Meanwhile, empowering patients to identify and seek help for any persistent symptoms, Dr Hancock says, is also vital to ensuring a timely diagnosis.
‘Some of these people might have chronic lung disease and they have a daily cough,’ she said.
‘But if their cough is different or they happen to cough up blood, then that’s not normal and they need to make sure that they get investigated.
‘And if they have had an investigation done by another service, just make sure that that investigation has been followed up. Don’t assume that “Somebody would have looked at it and if it was abnormal, they would have notified me” – we don’t have a foolproof health system. Patients do need to take a little bit of responsibility as well.’
While research and advancements in treatment mean that people with lung cancer are living better and longer lives, Dr Hancock says in the absence of a screening program being mindful of the clinical recommendations is crucial.
‘Lung cancer screening may be the only way we’re actually truly going to make a significant impact, which we don’t have at the moment,’ she said.
‘What we’re trying to do is find these lung cancers in the early stages where they can have treatment and get better outcomes because when they are diagnosed at stage three and stage four … the prognosis is so poor.’
For more information about the webinar ‘Investigating Symptoms of Lung Cancer: What’s the evidence?’ and to register, click here.
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