Pathways to the diagnosis of lung cancer in the UK: a cohort study

Background: Lung cancer is the commonest cause of cancer death in the UK. Patients generally present to their general practitioner, but the pathway of diagnosis from first symptom to diagnosis has not been mapped. We performed a cohort study of 246 patients with lung cancer in Exeter, Devon UK. All patients had their cancer symptoms, referrals and diagnoses identified and dated using their doctors' records. Results: Three main routes to diagnosis emerged. The first was the expected route of outpatient referral; 150 ( 61% of the cohort) of patients took this route, although only 110 ( 45% of the whole cohort, 73% of those referred to outpatients) were referred to a respiratory department. 56 ( 23%) were admitted as an emergency, having previously described a lung cancer symptom to their doctor. 26 patients ( 11%) had no symptom of lung cancer reported before their diagnosis. The interval from first symptom to referral was similar across the different pathways. However, the referral to diagnosis interval was longer in patients misdirected to other outpatient departments ( 66 days, interquartile range 37,110) than those sent to respiratory clinics ( 29 days, 17,61) or admitted as an emergency ( 16 days 8,40); p < 0.001. Conclusion: Only a minority of lung cancer patients follow the traditional route to diagnosis. Clinical and research efforts need to consider the alternative routes if they are to maximise their impact on speed of diagnosis.