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Lung Cancer
Referral Patterns
The Yorkshire Experience

This report was published by NYCRIS in April 2000 and is now available to download in acrobat pdf format.

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A paper has also recently been published in the British Journal of Cancer 7-Jan-2002, Vol 86, No1, pp36-42 (abstract, full text and pdf available)

Referral Pathways for Lung Cancer (abstract)

Guidelines for lung cancer management [1,2] always seem to assume that patients with lung cancer present in a typical fashion. Respiratory symptoms lead to a general practitioner consultation and then a referral, usually via an abnormal radiograph, to a chest physician and a standard hospital pathway of diagnosis and management. Clinical experience however indicates that this is far from the truth.

Since the Calman report [3] there has been increasing emphasis on making sure that cancer services provide access to specialist care for all patients with a working diagnosis of lung cancer. The possibility that a large proportion of patients might present to and be managed by non-specialists could profoundly effect the speed with which this could happen. There has never been a rigorous examination of referral pathways for lung cancer and this is now needed so that the pattern can be appreciated and service plans adjusted accordingly.

We have sought to provide this information using the relatively detailed database provided by the Northern & Yorkshire Cancer Registry. A 50 patient pilot study showed that we could obtain satisfactory information from patients' general practitioner and hospital records. We therefore expanded this to a definitive study; using a randomised stratified sampling technique, to obtain data which we think is applicable not only to lung cancer presenting in Yorkshire but very likely similar to that in other regions of the United Kingdom.

1. Whitehouse JMA.Management of lung cancer - current clinical practices: report of a working group. London: Standing Medical Advisory Committee; 1994

2. Scottish Intercollegiate Guidelines Network (SIGN). Management of Lung Cancer: A National Clinical Guideline recommended for use in Scotland - Pilot Edition (1998).

3. Department of Health. A policy framework for commissioning cancer services: a report by the Expert Advisory Group on Cancer to the Chief Medical Officers of England and Wales. London: Department of Health, 1995.