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

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.Lung cancer is the most common cause of cancer death in Canada.¹ Lung cancers are frequently diagnosed at a late stage, and the prognosis is very poor.¹ The chance of surviving lung cancer in Canada is low, with a 5-year survival rate of 13% for men and 19% for women.¹ Delays in the diagnosis of lung cancer are well documented.^2–11 This might in part be owing to patients and clinicians attributing the often common, atypical, or nonspecific symptoms of lung cancer to other, benign diseases.In order to provide guidance for the introduction of lung cancer diagnostic assessment programs (DAPs) in Ontario, the Cancer Care Ontario (CCO) Provincial Primary Care and Cancer Network initiated a collaboration in October 2009 with CCO’s Program in Evidence-based Care (PEBC) to form the Lung Cancer Referral Working Group. The working group was tasked with providing recommendations that would help FPs and other primary care providers recognize and initiate the management of undiagnosed patients presenting with signs or symptoms of lung cancer. The following questions were evaluated in completing this overall objective.

• What main known risk factors are predictive of lung cancer?
• What signs, symptoms, and other clinical features are predictive of lung cancer?
• What is the diagnostic accuracy of investigations for lung cancer?
• Which patient and provider factors are associated with delayed referral?
• Does a delay in the time to consultation affect patient outcomes?

The aim of this guideline is to assist primary care clinicians in recognizing and managing clinical features that should raise their suspicion of lung cancer and ultimately lead to more timely and appropriate referrals. The recommendations are targeted to managing patients presenting in primary care settings. They are also intended to help policy makers ensure that resources such as lung cancer DAPs are in place so that target wait times are achieved.