Many textbooks describe symptoms and signs of lung cancer but refer to old series of patients. To update knowledge about lung cancer presentation, a study was carried out on 1,277 consecutive lung cancer patients, who were seen in a single Institution from January 1989 to October 2002. A set of 33 anthropometric, clinical, physical, laboratory, radiological, pathological and follow-up variables was prospectively recorded for all patients. In addition, information was obtained concerning symptoms of alarm (i.e. potential concern), times to specialist referral and the mix of symptoms at presentation. Patients were carefully followed-up and their subsequent clinical course was recorded. Casual discovery with absence of symptoms occurred more frequently towards the end of the study period and the prevalence of chest pain became less common. No other time-dependent changes were found in the presenting symptoms. Delay in specialist referral was longer when presentation was provoked by cough or by the occurrence of systemic symptoms, such as weight loss, anorexia and asthenia. Referral delay was longer towards the end of the study, perhaps related to an increase in the number of elderly patients with co-morbidities. Both alarm and prevalence symptoms were strong predictors of the clinical outcome, as found in both univariate analysis (favourable: casual discovery and chest infection; unfavourable: chest pain, dyspnoea, systemic symptoms and symptoms of local or systemic dissemination) and in multivariate analysis (favourable: chest infection). Early presentation of lung cancer is characterised by a specific symptomatic pattern. Knowledge of this pattern may help to improve the rate of early diagnosis.

https://erj.ersjournals.com/content/erj/24/6/898.full.pdf

Lung cancer: clinical presentation and specialist referral time

Psychosocial Issues in Lung Cancer Patients (Part 1)

about health care 1 . The faults of the general practitioner include a limited capacity to recognize potential cancer symptoms and lack of referral to specialists. The role of the specialist in the delay in the diagnosis of lung cancer is related to deficiency in rapidly diagnosing and staging these patients. The delays related to the healthcare system can be reduced by introducing organizational changes such as rapid-response respiratory-care services that facilitate the collaboration between primary and specialized care providers 2 . It is universally acknowledged that the prognosis of lung cancer is very poor, with overall 5-year survival rates of about 5-10% worldwide 3 . The principal factors affecting prognosis in lung cancer are the stage-related performance status at presentation, histology (i.e., the biological activity of the tumor), comorbidities, and the patient’s age and sex. In theory, reducing the interval between presentation and treatment might allow the disease to be treated at a lower stage and lead to an improvement in survival 4 .

Effect of Symptom-To-Treatment Interval on Prognosis in Lung Cancer:

Lung cancer is a major cause of death in industrialized countries. In contrast to other cancers (e.g., breast), there have been few studies of quality of life, coping, behavioral interventions, and other psychosocial issues in patients with lung cancer. There are several possible explanations to consider. Metastatic disease is frequently present at the time of lung cancer diagnosis, and the limited survival time of these patients diminishes the opportunity for psychosocial investigations. Similarly, psychosocial interventions for patients with cancer are more likely to be applied in patients with longer survival times. In addition, the poor performance status and rapid disease progression in many lung cancer patients inhibits studies that require patient attentiveness and cognitive effort. Lastly, until recently, lung cancer has primarily affected men, and male patients may be more reluctant to participate in psychosocial research in which their emotional concerns are discussed.

Psychosocial issues in lung cancer patients

New chemotherapy agents in the treatment of advanced non-small cell lung cancer: an update including data from the Seventh World Conference on Lung Cancer.

The quality of diagnostic and therapeutic care was examined in a series of 380 consecutive newly diagnosed cases of primary lung cancer seen in 20 Italian general hospitals between January and June 1987. At diagnosis most patients (78%) had one or more symptoms related to the tumor, and in an additional 9 % symptoms were related to the presence of distant metastases. The median diagnostic time lag between first symptoms and final diagnosis was 50 days with a significantly longer delay in patients first seen by their general practitioner compared with those who sought first care in hospital outpatient departments. The diagnostic process was satisfactorily carried out in fewer than two-thirds of the patients leading to complete ascertainment of disease stage and histology in 58% cases with significantly better performance in more specialized institutions. Analysis of the first-line treatment profile indicated a rather aggressive therapeutic attitude In the case of patients with non-small cell lung cancer – 28% of them had chemotherapy despite the lack of any proof of efficacy in controlled clinical trials – and a failure to identify among the patients with small cell disease those amenable to more aggressive treatment. The lack of progress in the treatment of lung cancer over the last decades seems to have resulted in widely varying practice patterns where a mixture of aggressive and laissez-faire attitudes does not take into account that in the absence of effective therapies a more conservative attitude would at least have some advantage in terms of quality of remaining life for many patients.

V. Lanzetti

Papers

Diagnosis and first-line treatment of patients with lung cancer in Italian general hospitals

Cisplatin-vinorelbine (DDP+VBN) association chemotherapy in the treatment of locally advanced N.S.C.L.C.