{"id":44659,"date":"2019-05-21T14:17:01","date_gmt":"2019-05-21T13:17:01","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=44659"},"modified":"2019-05-21T15:20:01","modified_gmt":"2019-05-21T14:20:01","slug":"some-delays-in-lung-cancer-diagnosis-are-avoidable","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2019\/05\/21\/some-delays-in-lung-cancer-diagnosis-are-avoidable\/","title":{"rendered":"Some delays in lung cancer diagnosis are avoidable"},"content":{"rendered":"<p><em>Support to implement simple improvements could mean faster lung cancer diagnosis <\/em><\/p>\n<p>At the UK Lung Cancer Coalition\u2019s annual meeting last year, patients and clinicians gathered to explore how to achieve prompter diagnosis. \u00a0Some factors, such as profound staffing shortages and barriers in engaging those at high risk, [1] have no easy solutions. \u00a0Surprisingly, one frustration that resonated with delegates nationwide was a simple but widespread logistical problem that could be remedied with some common sense and leadership: assessment of renal function prior to administration of intravenous contrast for computed tomography\u2014the first crucial test for suspected lung cancer.<\/p>\n<p>Arranging a blood test to assess renal function doesn\u2019t sound hard but obtaining urgent blood tests for every patient is logistically very challenging and causes delay. \u00a0Even streamlined hospital protocols that recall patients for CT following an abnormal chest x-ray often face delays in scheduling prior blood tests.<\/p>\n<p>During difficult consultations about suspected lung cancer it can be challenging to raise the need for an extra test.\u00a0 After being told that their doctor suspects cancer, scheduling a blood test, in addition to scheduling the vital imaging that will exclude or confirm cancer, can be a barrier for patients. For patients who understandably dread the discovery of lung cancer or for whom engagement with health services is difficult, arranging an additional appointment for a blood test can make the difference between them accepting or declining the urgent CT investigation.\u00a0 For clinicians it can feel insensitive and unhelpful to burden patients with a series of appointments after communicating a possible cancer diagnosis.<\/p>\n<p>Delays could be avoided if the NHS implemented strategies such as point of care (\u201cfinger prick\u201d) blood testing, or initially imaging with non-contrast CT and accepting that those with lung cancer may require further contrast imaging for assessment of nodal and metastatic disease. In fact, goals like the incoming 28 day target for diagnosis from referral [2] are unlikely to succeed without pragmatic solutions like these.<\/p>\n<p>Some units have managed to implement point of care testing but have faced resistance due to concerns that the use of such novel technology has not been sanctioned by regulators and professional bodies.\u00a0 However, a NICE technology briefing has already reported evidence that point of care renal function tests correlate well with laboratory testing, and we are hopeful that further NICE guidance, due later this year, will help in overcoming the remaining barriers. [3, 4]<\/p>\n<p>We believe that the potential benefits of removing delays to diagnosis should drive a national consensus\u2014from bodies including NHS England, the Royal College of Radiologists, the British Thoracic Society, and the British Renal Society\u2014to support the implementation of streamlined diagnostic pathways such as those described above. These are simple, low cost solutions to expediting urgent lung cancer imaging; the leaders of these bodies could make a big difference.<\/p>\n<p>&nbsp;<\/p>\n<p><a href=\"https:\/\/blogs.bmj.com\/bmj\/files\/2019\/05\/StephenBradley150x150.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-44660 alignleft\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2019\/05\/StephenBradley150x150.jpg\" alt=\"\" width=\"150\" height=\"150\" \/><\/a><\/p>\n<p style=\"text-align: left\"><em><strong style=\"font-size: 1rem\">Stephen Bradley<\/strong><span style=\"font-size: 1rem\">\u00a0<\/span>is a GP and clinical research fellow at the University of Leeds @DryBreadnRadio\u00a0<\/em><\/p>\n<p style=\"text-align: left\"><em>Competing interests: Stephen Bradley is undertaking a PhD funded by Cancer Research UK<\/em><\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p><em><strong><a href=\"https:\/\/blogs.bmj.com\/bmj\/files\/2019\/05\/BobbyBhartia150x150.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-44661 alignleft\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2019\/05\/BobbyBhartia150x150.jpg\" alt=\"\" width=\"150\" height=\"150\" \/><\/a><\/strong><\/em><\/p>\n<p><em><strong>Bobby Bhartia<\/strong> is a consultant in thoracic and oncological radiology at\u00a0Leeds Teaching Hospitals NHS Trust<\/em><\/p>\n<p style=\"text-align: left\"><em>Competing interests: none declared<\/em><\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p><em><strong><a href=\"https:\/\/blogs.bmj.com\/bmj\/files\/2019\/05\/MartynKennedy150x150.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-44662 alignleft\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2019\/05\/MartynKennedy150x150.jpg\" alt=\"\" width=\"150\" height=\"150\" \/><\/a><\/strong><\/em><\/p>\n<p><em><strong>Martyn P. T. Kennedy<\/strong> is a consultant respiratory physician at Leeds Teaching Hospitals NHS Trust<\/em><\/p>\n<p style=\"text-align: left\"><em>Competing interests: none declared<\/em><\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p><strong>References<\/strong><\/p>\n<p>1. https:\/\/bmcpublichealth.biomedcentral.com\/articles\/10.1186\/s12889-016-3733-2<\/p>\n<p>2. <a href=\"https:\/\/www.england.nhs.uk\/cancer\/early-diagnosis\/\">https:\/\/www.england.nhs.uk\/cancer\/early-diagnosis\/<\/a><\/p>\n<p>3. https:\/\/www.nice.org.uk\/advice\/mib136\/chapter\/Summary<\/p>\n<p>4. https:\/\/www.nice.org.uk\/guidance\/indevelopment\/gid-dg10024\/documents<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Support to implement simple improvements could mean faster lung cancer diagnosis At the UK Lung Cancer Coalition\u2019s annual meeting last year, patients and clinicians gathered to explore how to achieve [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2019\/05\/21\/some-delays-in-lung-cancer-diagnosis-are-avoidable\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":44663,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[223],"tags":[],"class_list":["post-44659","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-guest-bloggers"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - 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