Lung cancer referrals fell by more than 25% during pandemic

Lung cancer referrals fell by more than a quarter during the pandemic due to confusion over symptoms and patients' fear of accessing healthcare, according to the Irish Cancer Society.

With referrals for the disease down 27 per cent between March and August on the previous year, the ICS estimates up to 244 patients with suspected symptoms of lung cancer could have been stopped from seeking necessary medical advice over the period.

Given the importance of early diagnosis, the charity has begun a new awareness campaign, “Your Cough Could be Masking Something Else”.

The campaign is designed to encourage people with a persistent cough to contact their GP, with a view to receiving a referral, or to seek guidance from the ICS through its support line or website.

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Lung cancer is the main cause of cancer deaths in Ireland for men and women – it accounts for 19 per cent of all cancer deaths in women and 23 per cent in men. Seventy per cent of those diagnosed with lung cancer are diagnosed at a late stage. More than 2,500 people receive a lung cancer diagnosis annually, and more than 1,800 men and women die each year from the cancer, which is largely preventable.

“The pandemic has made us all aware of coughing as it could be a symptom of Covid-19,” says Kevin O’Hagan, cancer prevention manager at the charity.

“However, it is important to remember that a persistent cough is also a symptom of lung cancer; like Covid-19, it is important to get it checked out straight away, irrespective of your age or existing health conditions. Early detection of lung cancer is vital and allows for greater treatment options and a real chance of a cure.”

Stigma

Professor Karen Redmond, consultant thoracic and lung transplant surgeon at the Mater Hospital, worries that potential stigma around Covid-19 is stopping people from contacting their doctor when they become unwell. As a result, large numbers of cancer patients are not seeking medical help.

“There might be an element of people not wanting to know what’s wrong or hoping that if they stay at home the situation will settle down. People who are screened for Covid and it comes back as negative may expect a cough will just settle. But if it is cancer it will progress to the next stage.”

In some cases, patients will need to be referred to a rapid access lung clinic to be screened for cancer, she added.

Before Covid-19, patients were advised to see a doctor if a cough persists for more than 2-3 weeks, said Prof Redmond. However, the Covid cough, which can last for months in some patients, has caused confusion.

“Numbers are way down and people are coming into us at a later stage of cancer. If you get people early there’s a chance of long term survival but at a later stage you’re going down the chemo and radiation or palliative care route. If you’re a 65 year old smoker coughing with no history of Covid you need to get to a rapid access clinic.”

Persistent cough

People with a family history of lung cancer who develop a persistent cough should also contact their GP for a screening referral, said Prof Redmond.

GP Dr Una Kennedy acknowledged that some patients might be reluctant to visit their doctor during the pandemic but underlined the importance of speaking to a health professional if new symptoms, particularly a persistent cough, arise.

“GPs have made huge changes in how we manage and run our surgeries during Covid-19,” she said. “We’re really conscious of being able to protect people who come to see us and take precautions every step of the way. We won’t bring you into the surgery unless it’s absolutely necessary. If we don’t know you’re out there with symptoms we can’t help you. We just need people to make contact.”

Dr Kennedy noted that lung cancer symptoms can be “vague and difficult to distinguish” but advised people to contact a doctor if they develop a persistent cough, lose weight without a change in diet, develop chest or shoulder pain which they cannot explain and become breathless when undertaking usual daily tasks.

Singer Mary Byrne, whose brother-in-law, Liam, and two sisters-in-law, Geraldine and Kathleen, died from lung cancer, said the ICA campaign was "very close " to her heart having lost three family members to the disease in the past nine years.

“If their cancers had been diagnosed earlier they could have had more treatment options and a greater chance of survival.”

Because of what happened to them, Ms Byrne says she gets regular check-ups. “My sisters-in-law were in their sixties when they were diagnosed. I’m 61 this year and I hope to be around until I’m at least in my 80s for my daughter and for myself. I’ve lost six and a half stone and quit smoking and the motivation for this is all down to losing family members so young.”