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

ObjectiveLung 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.DesignCase-control study.SettingAmbulatory care clinics at a large tertiary care academic health centre in the USA.Participants, outcomesWe 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.ResultsEleven 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 6months 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).ConclusionsPatients 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 6months or more before diagnosis. These findings suggest opportunities to improve the diagnostic process for lung cancer.