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Independents' Day

GPs left in muddle over antiplatelets

GPs should refer patients with haemoptysis for rapid investigation and possibly a chest X-ray to avoid delays in diagnosis of lung cancer, results of a large UK study suggest.

The results showed one in 40 patients with haemoptysis alone were diagnosed with lung cancer and, unlike other symptoms, haemoptysis was present more than a few months before diagnosis.

The study bolsters evidence in the NICE cancer referral guidelines on lung cancer, which rated the evidence for haemoptypsis referral as grade D, the lowest grade.

Research leader Dr William Hamilton, clinical research fellow in primary care at the University of Bristol, said most symptoms occurred quite late so any prospects for an early indicator were important.

He added: 'Rapid investigation of haemoptysis is the main area likely to yield

improvements in diagnostic delay. I believe all patients over 50 with haemoptysis should have a chest X-ray. It's in the guidelines, but isn't fully done by GPs.'

The study, presented last week at the Society for Academic Primary Care annual meeting in Gateshead, was based on 247 patients diagnosed with lung cancer between 1997 and 2000 compared with 1,235 controls.

The symptoms associated with the greatest likelihood of cancer were loss of appetite (86 per cent) and haemoptysis (32 per cent).

Dr Nick Brown, a GP in Chippenham and cancer lead for Kennet and North Wiltshire PCT, agreed that patients with haemoptysis should be sent for chest X-ray.

'Haemoptysis is not that uncommon so the question is when do you do another chest X-ray in patients who have already had one?

'Lung cancer is a difficult area and a lot of patients have chronic lung problems ­ so practically it's more complicated than it may seem from the guidelines.'

Symptom checklist

for lung cancer

Symptom Odds ratio

Loss of appetite 86

Haemoptysis 32

Finger clubbing 18

Current smoking 9.7

Raised platelets 9.3

Abnormal spirometry 7.5

Dyspnoea 4.7

Weight loss 4.3

Weakness/tiredness 3.2

Chest pain 2.9

Persistent cough 2.7

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