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‘Three-week cough’ campaign under fire from GP cancer leads

GP cancer leads have criticised the Government’s lung cancer awareness campaign, warning it will undo years of work persuading patients with minor ailments to stay at home.

The awareness campaign urges patients to see their GP if they have had a cough for three weeks or more as ‘it could be a sign of lung cancer’.

The campaign includes adverts on television and radio and in print and online media, and will run until the end of next month.

The campaign was piloted in the East and West Midlands last year and GPs there experienced a 23% increase in the number of people attending primary care and a 16% increase in chest X-ray referrals.

NICE guidelines recommend an urgent referral for a chest X-ray if patients have haemoptysis, or an unexplained symptom – such as cough, chest/shoulder pain or weight loss – for more than three weeks. But GPs have questioned the three-week message, saying it should be extended to around six weeks.

Dr Kiran Singh, a GP in Nuneaton, Warwickshire, and cancer lead for NHS Warwickshire, said it was confusing patients and made life difficult for GPs: ‘We are sending out conflicting messages and undoing what we have done for minor ailments.’

‘The duration of cough should be more like six weeks, and it should be more targeted to those in high risk groups.’

Dr Petula Chatterjee, GP cancer lead for NHS Manchester, agreed said the three-week duration should be extended to six weeks.

She said: ‘Cough is a common symptom in primary care. On its own, six weeks would be fine, and if associated with other symptoms of weight loss, neck or shoulder pain, feeling unwell, it is more significant.

 ‘We expect an increase in anxious patients as a result of the campaign and consequently onward investigations will also increase.’

But other GPs backed the initiative and said the three-week message would ensure that lung cancer was diagnosed earlier.

Dr David Plume, GP cancer lead for Norfolk Community Health and Care NHS Trust, said: ‘This will increase the number of people with post-viral coughs or poorly controlled asthma or COPD who present, but this may be no bad thing.’

‘This campaign is not designed to stop GPs using their clinical skills and acumen, and of course urgent chest X-rays are not needed on all patients with a cough for three weeks.

Dr Philip Sawyer, a GP in St Albans, Hertfordshire, and primary care lead of the NHS Mount Vernon Cancer Network, said the effect on GP attendance had been ‘minimal’ in his area, but the campaign had not included TV advertising.

He said:  ‘One of the key messages for primary care with this campaign is that we should lower our threshold for requesting CXRs in patient’s over 50 if we want to detect more early stage, and more treatable, lung cancers.’