Changes in the presenting symptoms of lung cancer from 2000–2017: a serial cross-sectional study of observational records in UK primary care

BACKGROUND: Most patients diagnosed with lung cancer present with symptoms. It is not known if the proportions of patients presenting with each symptom has changed over time. Identifying trends in lung cancer’s presenting symptoms is important for medical education and early-diagnosis initiatives. AIM: To identify the first reported symptom of possible lung cancer (index symptom), and to test whether the percentages of patients with each index symptom changed during 2000–2017. DESIGN AND SETTING: This was a serial, cross-sectional, observational study using UK Clinical Practice Research Datalink (CPRD) data with cancer registry linkage. METHOD: The index symptom was identified for patients with an incident diagnosis of lung cancer in annual cohorts between 1 January 2000 and 31 December 2017. Searches were constrained to symptoms in National Institute for Health and Care Excellence (NICE) suspected-cancer referral guidelines, and to the year before diagnosis. Generalised linear models (with a binomial function) were used to test if the percentages of patients with each index symptom varied during 2000–2017. RESULTS: The percentage of patients with an index symptom of cough (odds ratio [OR] 1.01; 95% confidence interval [CI] = 1.00 to 1.02 per year; P<0.0001) or dyspnoea (OR 1.05; CI = 1.05 to 1.06 per year; P<0.0001) increased. The percentages of patients with other index symptoms decreased, notably haemoptysis (OR 0.93; CI = 0.92 to 0.95; P<0.0001) and appetite loss (OR 0.94; CI = 0.90 to 0.97; P<0.0001). CONCLUSION: During 2000–2017, the proportions of lung cancer patients with an index symptom of cough or dyspnoea increased, while the proportion of those with the index symptom haemoptysis decreased. This trend has implications for medical education and symptom awareness campaigns.