Clinical signs may aid in selection of patients for lung cancer testing

A group of clinicians from the UK have identified ten clinical features, apart from cigarette smoking, that are independently associated with the future development of lung cancer.

As reported in the December issue of Thorax, the ten features include seven symptoms (hemoptysis, loss of weight, loss of appetite, dyspnea, thoracic pain, fatigue, cough); one physical sign (finger clubbing); and two abnormal investigation results (thrombocytosis and abnormal spirometry). After excluding variables reported in the final 180 days before diagnosis, three of these features (hemoptysis, dyspnea, and abnormal spirometry) plus smoking remained associated with lung cancer. The findings are based on a population-based case-control study conducted in all 21 general practices in Exeter, a town with a population of 128,700. A total of 247 primary lung cancers were investigated in subjects over 40 years of age and compared with1235 matched controls without lung cancer.”Until this study was performed, the decision about when to investigate a patient with possible lung cancer has had a very weak evidence base,” Dr. W. Hamilton from the University of Bristol and colleagues note. “Our results,” they say, “can guide doctors when to consider investigation in patients with a symptom or symptoms that could represent lung cancer.” Moreover, the results can be used by healthcare organizations to “improve guidelines for selection of patients for rapid investigation, and also to inform the general public.””The one symptom patients do not delay reporting to their doctor is haemoptysis,” Dr. Hamilton and colleagues explain. “However, this is a relatively uncommon symptom of lung cancer and more benefit may be gained from educating the public about persistent cough and dyspnoea.” (Source: Thorax 2005;60:1059-1065: Reuters Health: Oncolink: December 2005.)