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Symptoms that predict chest X-ray results suspicious for lung cancer in UK primary care: results from a prospective study

Symptoms that predict chest X-ray results suspicious for lung cancer in UK primary care: results from a prospective study
Symptoms that predict chest X-ray results suspicious for lung cancer in UK primary care: results from a prospective study
Background/introduction:?Predictive values of lung cancer (LC) symptoms that inform UK LC referral guidelines have been calculated from GP records and databases, with the potential for recording bias by GPs. The Identifying Symptom Predictors of Chest and Respiratory Disease (IPCARD) self-completion questionnaire was designed, for use in prospective studies, to obtain accurate positive predictive values (PPVs) of patient-elicited potential LC symptoms. The IPCARD Feasibility Study provides the first prospectively collected, patient-elicited comprehensive symptom data to identify PPVs of potential LC symptoms in UK primary care.

Research question:?Which patient-elicited symptoms predict chest X-rays (CXR) suspicious for LC in a GP-referred CXR population (LC incidence 1%)?

Methods:?GP-referred CXR attendees (1414) at three UK sites completed IPCARD before CXR; LC diagnosis was obtained 6 months post-CXR. Multiple logistic regression was used to calculate PPVs of symptoms for abnormal CXR, adjusting for age and sex; and stratifying by smoking status and COPD.

Results:?Common chest symptoms – cough for longer than 3 weeks, generic chest aches/pains, and breathlessness – did not predict suspicious CXR. Weight loss and less common variants of chest pain (pain in side of chest/ribs, severe pain, and pain that ‘feels like indigestion – not associated with eating’ in patients with non-progressive/less severe pain) predicted CXR suspicious for LC in this high risk, referred population.

Discussion/conclusion:?Common chest systems, identified as referral criteria by NICE, and included in UK ‘Be Clear about Cancer’ public awareness campaigns, although potentially predicting LC in a lower risk pre-referral population, did not predict CXR suspicious for LC in this referred population with higher rates of non-malignant chest and respiratory disease. The possibility that weight loss, and variants of chest pain, might also predict LC in pre-referral primary care populations with chronic respiratory disease will be investigated in ongoing studies using IPCARD.
Brindle, Lucy
17158264-2a99-4786-afc0-30990240436c
Hamilton, W.
8739428e-d582-496a-b915-80f1c98afaef
Banerjee, Anindo
cbbef68b-3cef-42b2-86a4-2f94df3f1288
Dowswell, G.
ab167410-ce1e-43a7-99df-556273a1b249
Brindle, Lucy
17158264-2a99-4786-afc0-30990240436c
Hamilton, W.
8739428e-d582-496a-b915-80f1c98afaef
Banerjee, Anindo
cbbef68b-3cef-42b2-86a4-2f94df3f1288
Dowswell, G.
ab167410-ce1e-43a7-99df-556273a1b249

Brindle, Lucy, Hamilton, W., Banerjee, Anindo and Dowswell, G. (2014) Symptoms that predict chest X-ray results suspicious for lung cancer in UK primary care: results from a prospective study. Winnipeg 2014 - 7th meeting of Ca-PRI, Winnipeg, Canada. 10 - 13 Jun 2014.

Record type: Conference or Workshop Item (Poster)

Abstract

Background/introduction:?Predictive values of lung cancer (LC) symptoms that inform UK LC referral guidelines have been calculated from GP records and databases, with the potential for recording bias by GPs. The Identifying Symptom Predictors of Chest and Respiratory Disease (IPCARD) self-completion questionnaire was designed, for use in prospective studies, to obtain accurate positive predictive values (PPVs) of patient-elicited potential LC symptoms. The IPCARD Feasibility Study provides the first prospectively collected, patient-elicited comprehensive symptom data to identify PPVs of potential LC symptoms in UK primary care.

Research question:?Which patient-elicited symptoms predict chest X-rays (CXR) suspicious for LC in a GP-referred CXR population (LC incidence 1%)?

Methods:?GP-referred CXR attendees (1414) at three UK sites completed IPCARD before CXR; LC diagnosis was obtained 6 months post-CXR. Multiple logistic regression was used to calculate PPVs of symptoms for abnormal CXR, adjusting for age and sex; and stratifying by smoking status and COPD.

Results:?Common chest symptoms – cough for longer than 3 weeks, generic chest aches/pains, and breathlessness – did not predict suspicious CXR. Weight loss and less common variants of chest pain (pain in side of chest/ribs, severe pain, and pain that ‘feels like indigestion – not associated with eating’ in patients with non-progressive/less severe pain) predicted CXR suspicious for LC in this high risk, referred population.

Discussion/conclusion:?Common chest systems, identified as referral criteria by NICE, and included in UK ‘Be Clear about Cancer’ public awareness campaigns, although potentially predicting LC in a lower risk pre-referral population, did not predict CXR suspicious for LC in this referred population with higher rates of non-malignant chest and respiratory disease. The possibility that weight loss, and variants of chest pain, might also predict LC in pre-referral primary care populations with chronic respiratory disease will be investigated in ongoing studies using IPCARD.

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More information

Published date: June 2014
Venue - Dates: Winnipeg 2014 - 7th meeting of Ca-PRI, Winnipeg, Canada, 2014-06-10 - 2014-06-13
Organisations: Faculty of Health Sciences

Identifiers

Local EPrints ID: 378929
URI: http://eprints.soton.ac.uk/id/eprint/378929
PURE UUID: 145b998c-33b7-4d70-8227-3c7d3ebca445
ORCID for Lucy Brindle: ORCID iD orcid.org/0000-0002-8933-3754

Catalogue record

Date deposited: 13 Jul 2015 11:21
Last modified: 23 Jul 2022 01:55

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Contributors

Author: Lucy Brindle ORCID iD
Author: W. Hamilton
Author: Anindo Banerjee
Author: G. Dowswell

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