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24 May

Understanding how to tackle early lung cancer detection in high-risk communities

Cigarette broken in half

Dr Grace McCutchan, a researcher for the Wales Cancer Research Centre, has recently published her findings on engaging high-risk groups in early lung cancer diagnosis. Her research has revealed that easy to access information delivered by trained and approachable members of the local community may encourage people who have a high risk of developing lung cancer to get medical help with lung symptoms.

Lung cancer is the leading cause of cancer death worldwide. Outcomes are among the poorest for all cancers, with only 13% of lung cancer patients surviving five or more years in the UK. Finding lung cancer early really improves a patient’s chances after surgery; over 80% of patients will survive one year or more when diagnosed at Stage I. Sadly, however, lung cancer is more commonly diagnosed at an advanced, incurable stage. Therefore, we need to understand why people may put off going to the doctor with lung cancer symptoms, and how we can best to support them to seek medical help when symptoms develop.

People who are high risk for lung cancer – current/former smokers, aged 40 years and over, who have a lung condition and live in the most deprived areas of the UK – report prolonged medical help seeking with lung cancer symptoms. Lung cancer is more common and mortality is higher in areas of high socioeconomic deprivation; it has been estimated that each year, socioeconomic inequalities account for 11,700 excess cases of lung cancer and 9,900 potentially avoidable lung cancer deaths in England.

Dr McCutchan conducted interviews with 37 individuals who were high risk for lung cancer from the most deprived areas of the UK (South Wales, North England, North East Scotland). She also conducted focus groups with patients and healthcare professionals to explore how best to support and encourage early help seeking in people who are high risk for lung cancer.

Her research found that some people thought that doctors wouldn’t want to treat them because of perceived stigma against smokers, or because they live in deprived areas and often in difficult circumstances. In the lead up to lung cancer diagnosis, vague symptoms may go unnoticed or not be considered a legitimate symptom to seek medical attention for, and these symptoms were often misattributed to smoking, aging or other conditions such as their lung condition. Participants described how they would put off going to the GP until their symptoms were painful or they couldn’t do normal day-to-day activities. Even though most of the people involved in the study thought that they were going to get lung cancer at some point in their lives, many were too scared to seek help because they were worried about what the doctor might find. Many of the participants were unaware that the chances of surviving lung cancer are greatly improved if lung cancer is detected early. Some people tried to not think about lung cancer or worrying symptoms because getting a diagnosis of lung cancer would be too much to deal with; getting by day-to-day was their main concern.

To empower people to get help early with lung cancer symptoms, participants in the study said they needed more information about lung cancer symptoms and why it is important to seek medical help early. They suggested distributing information in different ways and in places where it was easy for people to access, such as local events and posters in community centres. Importantly, the information should be delivered by someone who people can relate to and who won’t judge them for their smoking.

Dr McCutchan said “Learning about how best to support people who are high risk to seek medical help when they notice new or changing symptoms is really important. This is because we know that when lung cancer is diagnosed early, more treatments are available, meaning patients are more likely to survive lung cancer. This study found that high risk people put off going to the doctor because they don’t feel worthy of receiving medical help with lung cancer symptoms, and because help seeking for respiratory-type symptoms was low in priority. Relationships, however, were important motivators for help seeking; the need to stay healthy to look after younger children and having a supportive, non-judgemental healthcare professional would encourage help seeking. Our study found that health interventions targeted at high risk, highly deprived groups should be delivered by people who they can relate to like trained lay members of the community who are trusted and approachable, to highlight the significance of symptoms and the importance of early lung cancer diagnosis.”

Dr McCutchan and her team are currently working with Cwm Taf University Health Board using the findings from this study to develop a campaign to encourage people to seek help when they suspect cancer symptoms.