What happens in general practice before an emergency lung cancer diagnosis?

Today, we’re speaking to Marta Berglund, a Research Assistant and PhD candidate at University College London.

Title of paper: Pre-diagnostic primary care consultations and imaging in emergency-diagnosed vs referred lung cancer patients

Available at: https://doi.org/10.3399/BJGP.2025.0369

It has been postulated that emergency diagnoses of cancer (which occurs frequently and confers a poorer prognosis) may relate to suboptimal diagnostic management in primary care, but evidence to support or refute this hypothesis is sparse. We found that emergency-diagnosed patients with lung cancer were less likely to present with relevant respiratory symptoms and had fewer chest imaging investigations before diagnosis compared to patients diagnosed via referred routes, indicating an important role of disease factors in emergency diagnosis.

Transcript

This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.

Speaker A

00:00:01.200 - 00:01:06.690

Hello and welcome to BJGP Interviews. I'm Nada Khan and I'm one of the Associate editors of the Journal. Thanks for listening to this podcast today.

In today's episode, we're speaking to Marta Bergland. Marta is a research assistant and PhD candidate at university College London.

She's recently published a paper here in the BJGP titled Pre Diagnostic Primary Care Consultations and Imaging in Emergency Diagnosed versus Referred Lung Cancer Patients.

So, hi, Marta, it's really lovely to meet you and it's great to talk to you about cancer diagnosis, which is a really important area for general practice and also a topic we publish on quite a lot here in the bjgp. It's been fascinating reading this paper and it tackles a cancer that we really don't do well with here in the UK in terms of early diagnosis.

But I wonder if you could just start off by telling us a little bit more about lung cancer and how it's actually often diagnosed, which can sometimes lead to some of those poor outcomes.

Speaker B

00:01:07.010 - 00:02:26.970

So, as you said, lung cancer is one of the cancer sites in the UK where the majority or a large proportion of patients are diagnosed through the emergency route, also known as emergency presentations, which is when a patient is diagnosed after they present through an urgent hospital admission or an A and E attendance in the 30 days before diagnosis.

And that could look like someone who has had a persistent cough for, say, two weeks, but didn't actually go to their gp, and then suddenly they have a more severe onset of symptoms like shortness of breath, and then they go to A and E and are referred to a chest X ray and then get diagnosed, which is a pathway that is associated with worse prognosis and worse outcomes after diagnosis. And the more preferred route, if you will, in England to diagnose patients is through primary care.

So through the GP routine referral or the urgent suspected referral route.

And that could look like someone who presents to primary care with cough or dyspneasia again, but then their GP refers them to a chest X ray and then they're diagnosed with lung cancer.

Speaker A

00:02:27.130 - 00:02:45.290

And I guess I wanted to just before we talk about what you found, I wanted to just cover here again, what you mean by this term, that's diagnostic window, because you mentioned that a few times in the paper. But what does this actually mean?

And it relates a bit back to some of what you're talking about, about people presenting with symptoms, isn't that right?

Speaker B

00:02:45.530 - 00:03:09.880

So, for us, it's a measure of healthcare use before diagnosis, and it could be any healthcare use Measure like consultations, symptoms, blood test use, anything like that.

And it's measuring when that changes compared to baseline before diagnosis, which can signal increased healthcare use associated with the subsequent diagnosis.

Speaker A

00:03:10.040 - 00:03:16.840

Okay, so it just, I guess it's what it says on the tin. It's just that window, isn't it, of potentially being able to pick up a change.

Speaker B

00:03:17.490 - 00:03:25.970

Exactly. So the idea is that if there is an increase long before diagnosis, then possibly there is an opportunity to diagnose these patients earlier.

Speaker A

00:03:26.450 - 00:04:09.190

So this was a really big study using the CPRD and this is a database that a lot of the listeners will be familiar with.

And you had a sample of a million patients registered with UK General Practice and then you looked at people diagnosed with cancer and their pre diagnosis rates of consultation like you were talking about, and also chest imaging by the different possible diagnosis routes. So either as an emergency, a routine or an urgent referral. But I really want to move straight to what you found here.

Can you give us just an overview of how the different people in this analysis were eventually diagnosed with lung cancer? So were there a lot of emergency diagnoses here?

Speaker B

00:04:09.350 - 00:05:46.240

Yes, I believe we had around 30% of patients who were diagnosed through the emergency route, compared to 20 something percent in the urgent referral route and the GP routine referral route. That aligns with the national data in NCRAS and also the Rapid Cancer Registry data. I guess that's what we expected to see.

We found that the majority of pa