Symptoms and signs of lung cancer prior to diagnosis: case–control study using electronic health records from ambulatory care within a large US-based tertiary care centre
Richard D Neal,
Fiona M Walter,
Morhaf Al Achkar,
Monica Zigman Suchsland,
Grace Turner,
Matthew J Thompson,
Larry G Kessler,
Farhood Farjah,
Caroline A Thompson,
Maria G Prado,
Margaret A Au,
Hannah A Burkhardt,
Lesleigh Kowalski,
Kari A Stephens,
Meliha Yetisgen,
Kevin Lybarger,
Elizabeth A Sarma
Affiliations
Richard D Neal
Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
Fiona M Walter
Wolfson Institute of Population Health, Queen Mary University of London Barts and The London School of Medicine and Dentistry, London, UK
Morhaf Al Achkar
9 Oncology, Wayne State University/Karmanos Cancer Institute, Detroit, MI, USA
Monica Zigman Suchsland
University of Washington, Seattle, Washington, USA
Grace Turner
Centre for Patient-Reported Outcomes Research, University of Birmingham, Birmingham, UK
Matthew J Thompson
1 Department of Family Medicine, University of Washington, Seattle, Washington, USA
Larry G Kessler
Health Services, University of Washington, Seattle, Washington, USA
Farhood Farjah
Department of Surgery, University of Washington, Seattle, Washington, USA
Caroline A Thompson
Department of Epidemiology, The University of North Carolina, Chapel Hill, North Carolina, USA
Maria G Prado
Department of Family Medicine, University of Washington, Seattle, Washington, USA
Margaret A Au
Department of Family Medicine, University of Washington, Seattle, Washington, USA
Hannah A Burkhardt
Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, USA
Lesleigh Kowalski
Department of Family Medicine, University of Washington, Seattle, Washington, USA
Kari A Stephens
Department of Family Medicine, University of Washington, Seattle, Washington, USA
Meliha Yetisgen
Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, USA
Kevin Lybarger
Department of Information Sciences and Technology, George Mason University, Fairfax, Virginia, USA
Elizabeth A Sarma
National Cancer Institute, NIH, Bethesda, Maryland, USA
Objective Lung cancer is the most common cause of cancer-related death in the USA. While most patients are diagnosed following symptomatic presentation, no studies have compared symptoms and physical examination signs at or prior to diagnosis from electronic health records (EHRs) in the USA. We aimed to identify symptoms and signs in patients prior to diagnosis in EHR data.Design Case–control study.Setting Ambulatory care clinics at a large tertiary care academic health centre in the USA.Participants, outcomes We studied 698 primary lung cancer cases in adults diagnosed between 1 January 2012 and 31 December 2019, and 6841 controls matched by age, sex, smoking status and type of clinic. Coded and free-text data from the EHR were extracted from 2 years prior to diagnosis date for cases and index date for controls. Univariate and multivariable conditional logistic regression were used to identify symptoms and signs associated with lung cancer at time of diagnosis, and 1, 3, 6 and 12 months before the diagnosis/index dates.Results Eleven symptoms and signs recorded during the study period were associated with a significantly higher chance of being a lung cancer case in multivariable analyses. Of these, seven were significantly associated with lung cancer 6 months prior to diagnosis: haemoptysis (OR 3.2, 95% CI 1.9 to 5.3), cough (OR 3.1, 95% CI 2.4 to 4.0), chest crackles or wheeze (OR 3.1, 95% CI 2.3 to 4.1), bone pain (OR 2.7, 95% CI 2.1 to 3.6), back pain (OR 2.5, 95% CI 1.9 to 3.2), weight loss (OR 2.1, 95% CI 1.5 to 2.8) and fatigue (OR 1.6, 95% CI 1.3 to 2.1).Conclusions Patients diagnosed with lung cancer appear to have symptoms and signs recorded in the EHR that distinguish them from similar matched patients in ambulatory care, often 6 months or more before diagnosis. These findings suggest opportunities to improve the diagnostic process for lung cancer.
