Guideline for referral of patients with suspected lung cancer by family physicians and other primary care providers

Our plain-English summary of Guideline for referral of patients with suspected lung cancer by family physicians and other primary care providers, by M.E. Del Giudice, S.M. Young, E.T. Vella, et al (Canadian Family Physician Médecin de Famille Canadien, 2014).

The study

• Authors: M.E. Del Giudice, S.M. Young, E.T. Vella, M. Ash, P. Bansal, A. Robinson, R. Skrastins, Y. Ung, R. Zeldin, C. Levitt
• Journal: Canadian Family Physician Médecin de Famille Canadien
• Published: 2014;60(8):711-6, e376-82
• Type of article: Systematic review
• Language: French
• Cited by: 20 articles, as counted by NIH iCite
• Read it: PubMed · Free full text

Abstract

Objective: The aim of this guideline is to assist FPs and other primary care providers with recognizing features that should raise their suspicions about the presence of lung cancer in their patients.

Composition Of The Committee: Committee members were selected from among the regional primary care leads from the Cancer Care Ontario Provincial Primary Care and Cancer Network and from among the members of the Cancer Care Ontario Lung Cancer Disease Site Group.

Methods: This guideline was developed through systematic review of the evidence base, synthesis of the evidence, and formal external review involving Canadian stakeholders to validate the relevance of recommendations.

Report: Evidence-based guidelines were developed to improve the management of patients presenting with clinical features of lung cancer within the Canadian context.

Conclusion: Earlier identification and referral of patients with lung cancer might ultimately help improve lung cancer morbidity and mortality. These guidelines might also be of value for informing the development of lung cancer diagnostic programs and for helping policy makers to ensure appropriate resources are in place.

Copyright© the College of Family Physicians of Canada.

In plain English

This article was a clinical practice guideline for Canadian primary care providers, not an original study of patients. A ten-member working group linked to Cancer Care Ontario built it by adapting earlier guidelines, chiefly New Zealand's (2009) and the UK NICE's (2005), plus an updated literature search and expert opinion. Its list of lung cancer risk factors, taken from those guidelines, included previous exposure to asbestos or other known carcinogens, along with smoking and occupational dust exposure. It recommended a chest x-ray within 2 working days for warning signs such as coughing up blood, or for unexplained symptoms such as a cough lasting more than 3 weeks. It advised against sputum cytology (testing coughed-up mucus for cancer cells). Suspicious x-ray findings, or a high clinical suspicion despite a normal x-ray, called for a chest CT scan within 2 weeks and specialist referral within 1 to 2 weeks. The authors noted that the recommended wait times rested on expert opinion, and that there was no published evidence on how wait times affect patient outcomes. The authors concluded that the guideline could help reduce delays in lung cancer diagnosis.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Clinical practice guideline, developed by adapting existing guidelines (mainly NZGG 2009 and NICE 2005) with a systematic review, an updated literature search, expert opinion and internal and external review
• Who was studied: No patients were studied. The guideline is for family physicians and other primary care providers seeing patients with suspected lung cancer in Canada (Ontario). It was written by a working group of 10: 5 family physicians, 1 medical oncologist, 1 respirologist, 1 radiation oncologist, 1 thoracic surgeon and 1 methodologist, formed in 2009.
• Exposure: Not an exposure study. Previous exposure to asbestos or other known carcinogens (radon, chromium, nickel) is listed among factors that increase lung cancer risk. The list was based on the NICE 2005 and NZGG 2009 guidelines.
• Main results:
  • The risk factor list (which includes asbestos exposure) was based on the NICE 2005 literature review as summarized by NZGG 2009.
  • A chest x-ray within 2 working days is recommended for signs such as hemoptysis, new finger clubbing, suspicious lymphadenopathy or dysphagia, or for unexplained symptoms such as cough lasting more than 3 weeks.
  • Sputum cytology is not recommended for investigating suspected lung cancer.
  • A chest CT scan within 2 weeks is recommended for abnormal chest x-ray findings suspicious for lung cancer, or for normal x-ray findings with high clinical suspicion.
  • Referral to a specialist or diagnostic assessment program, with consultation within 1 to 2 weeks, is recommended for persistent hemoptysis, suspicious chest x-ray findings, or a normal x-ray with high clinical suspicion. The recommendation to refer despite a normal x-ray rests on high false-negative rates of chest x-rays.
  • Immediate referral to the emergency department is recommended for signs of superior vena cava obstruction, stridor, massive hemoptysis, or new neurologic signs suggestive of brain metastases or cord compression.
• The authors' conclusion: The authors concluded that the guideline could help reduce delays in lung cancer diagnosis by helping primary care providers recognize suspicious clinical features and make more timely referrals. They added that it might also guide diagnostic program development and resource planning.
• Limitations the authors state:
  • Recommended wait times were based on the expert opinion and consensus of the working group.
  • There is no published evidence on the effects of wait times on patient outcomes.
  • The updated literature search found few studies on thoracic CT in suspected lung cancer, so the CT indications drew on a 2005 Scottish guideline and expert opinion.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer.

Medical terms in this study, explained in our Lexicon: Lung Cancer, Systematic Review.

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