Symptoms and signs of lung cancer prior to diagnosis: case-control study using electronic health records from ambulatory care within a large US-based tertiary care centre

Maria G Prado; Larry G Kessler; Margaret A Au; Hannah A Burkhardt; Monica Zigman Suchsland; Lesleigh Kowalski; Kari A Stephens; Meliha Yetisgen; Fiona M Walter; Richard D Neal; Kevin Lybarger; Caroline A Thompson; Morhaf Al Achkar; Elizabeth A Sarma; Grace Turner; Farhood Farjah; Matthew J Thompson

doi:10.1136/bmjopen-2022-068832

Symptoms and signs of lung cancer prior to diagnosis: case-control study using electronic health records from ambulatory care within a large US-based tertiary care centre

BMJ Open. 2023 Apr 20;13(4):e068832. doi: 10.1136/bmjopen-2022-068832.

Authors

Maria G Prado¹, Larry G Kessler², Margaret A Au¹, Hannah A Burkhardt³, Monica Zigman Suchsland¹, Lesleigh Kowalski¹, Kari A Stephens¹, Meliha Yetisgen³, Fiona M Walter^{4

5}, Richard D Neal⁶, Kevin Lybarger⁷, Caroline A Thompson^{8

9}, Morhaf Al Achkar¹, Elizabeth A Sarma¹⁰, Grace Turner³, Farhood Farjah¹¹, Matthew J Thompson¹²

Affiliations

¹ Department of Family Medicine, University of Washington, Seattle, Washington, USA.
² Health Services, University of Washington, Seattle, Washington, USA.
³ Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, USA.
⁴ Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
⁵ The Primary Care Unit Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
⁶ University of Exeter, Exeter, UK.
⁷ Department of Information Sciences and Technology, George Mason University, Fairfax, Virginia, USA.
⁸ Department of Epidemiology, The University of North Carolina, Chapel Hill, North Carolina, USA.
⁹ Division of Epidemiology and Biostatistics, San Diego State University, San Diego, California, USA.
¹⁰ National Cancer Institute, NIH, Bethesda, Maryland, USA.
¹¹ Department of Surgery, University of Washington, Seattle, Washington, USA.
¹² Department of Family Medicine, University of Washington, Seattle, Washington, USA mjt@uw.edu.

Abstract

Objective: Lung cancer is the most common cause of cancer-related death in the USA. While most patients are diagnosed following symptomatic presentation, no studies have compared symptoms and physical examination signs at or prior to diagnosis from electronic health records (EHRs) in the USA. We aimed to identify symptoms and signs in patients prior to diagnosis in EHR data.

Design: Case-control study.

Setting: Ambulatory care clinics at a large tertiary care academic health centre in the USA.

Participants, outcomes: We studied 698 primary lung cancer cases in adults diagnosed between 1 January 2012 and 31 December 2019, and 6841 controls matched by age, sex, smoking status and type of clinic. Coded and free-text data from the EHR were extracted from 2 years prior to diagnosis date for cases and index date for controls. Univariate and multivariable conditional logistic regression were used to identify symptoms and signs associated with lung cancer at time of diagnosis, and 1, 3, 6 and 12 months before the diagnosis/index dates.

Results: Eleven symptoms and signs recorded during the study period were associated with a significantly higher chance of being a lung cancer case in multivariable analyses. Of these, seven were significantly associated with lung cancer 6 months prior to diagnosis: haemoptysis (OR 3.2, 95% CI 1.9 to 5.3), cough (OR 3.1, 95% CI 2.4 to 4.0), chest crackles or wheeze (OR 3.1, 95% CI 2.3 to 4.1), bone pain (OR 2.7, 95% CI 2.1 to 3.6), back pain (OR 2.5, 95% CI 1.9 to 3.2), weight loss (OR 2.1, 95% CI 1.5 to 2.8) and fatigue (OR 1.6, 95% CI 1.3 to 2.1).

Conclusions: Patients diagnosed with lung cancer appear to have symptoms and signs recorded in the EHR that distinguish them from similar matched patients in ambulatory care, often 6 months or more before diagnosis. These findings suggest opportunities to improve the diagnostic process for lung cancer.

Keywords: Health informatics; PRIMARY CARE; Respiratory tract tumours; Thoracic medicine.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Ambulatory Care
Case-Control Studies
Electronic Health Records*
Humans
Lung Neoplasms* / diagnosis
Tertiary Care Centers

Abstract

Publication types

MeSH terms

Grants and funding