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General practice fails to diagnose lung cancer

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Primary care nurses and GPs are missing opportunities to diagnose lung cancer, a study published in Thorax suggested.

The study of 20,142 people aged over 30 diagnosed with lung cancer compared those who died early (within 90 days of diagnosis) and those who survived longer. It showed that patients who had died early had visited their general practice a median of five times, compared with four times for patients who survived beyond three months. This shows there is not a lack of engagement with services from patients. Rather, the authors suggested, it means that GPs and practice nurses are repeatedly failing to identify the disease.

The study also showed that the number of early deaths from lung cancer was highest in general practices that carried out the least chest x-rays.

Practice nurses could improve diagnosis by spotting early indicators of the disease, said Dr Jesme Fox, medical director at the Roy Castle Lung Cancer Foundation. 'What is obvious from this study is that lung cancer is being missed in primary care. Practice nurses should have an index of suspicion about lung cancer. For example, if a patient presents with a cough, it could be a variety of things. However, if the patient returns with a noticeably worse cough, the nurse should consider referring the patient for a chest x-ray or specialist advice.' Dr Fox also said that nurses could consult the NICE cancer referral guidelines for clarity around lung cancer referrals.

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