Achieving earlier diagnosis of symptomatic lung cancer

Lung cancer is the largest cause of cancer death, with 1.8 million deaths worldwide per year.1 Despite important improvements in treatment, outcomes remain poor compared with other common cancers. In England and Wales 1-year survival is only 48%.2 Stage of cancer and performance status (PS) are the strongest independent predictors of survival. The adjusted hazard ratio for death was 4.39 for PS 4 (the most impaired PS category) compared with PS 0 (the least impaired category) and 4.58 for stage IV compared with IA–IB in the English National Lung Cancer Audit.3 Unfortunately, almost half of patients with lung cancer are diagnosed with stage IV disease in England4 and 47% of patients present at PS 2–45 when they are not eligible for most systemic treatments. Furthermore, systemic treatments are more effective in patients who are fitter. Achieving diagnosis of lung cancer in earlier stages of the disease is therefore crucial to improving survival.