Clinical update

Lung cancer or COVID-19? How to differentiate between their similar presentations

A new resource helps patients and nurses differentiate between symptoms of COVID-19 and lung cancer

A new resource helps patients and nurses differentiate between symptoms of COVID-19 and lung cancer

Essential facts

About 47,800 people in the UK are diagnosed with lung cancer each year, according to Cancer Research UK (CRUK). It is the most common cause of cancer death in the UK, responsible for in excess of 35,000 deaths a year and equivalent to more than one fifth of all deaths from cancer, says the charity. More than one third of lung cancer cases are diagnosed when someone presents as an emergency, with almost nine

A new resource helps patients and nurses differentiate between symptoms of COVID-19 and lung cancer

Coughing is a symptom of COVID-19 and lung cancer
Coughing is a symptom of COVID-19 and lung cancer Picture: iStock

Essential facts

About 47,800 people in the UK are diagnosed with lung cancer each year, according to Cancer Research UK (CRUK). It is the most common cause of cancer death in the UK, responsible for in excess of 35,000 deaths a year and equivalent to more than one fifth of all deaths from cancer, says the charity. More than one third of lung cancer cases are diagnosed when someone presents as an emergency, with almost nine in ten of these patients already at stage 3 or 4.

Urgent referrals for suspected lung cancer have seen a sustained reduction as a result of the COVID-19 pandemic, says CRUK. In England and Wales, urgent referrals for suspected lung cancer were 35% lower between March and November 2020 compared with the same time period in 2019. This equates to about 17,800 fewer people.

In addition, lung cancer and COVID-19 share similar symptoms of a cough, breathlessness and fatigue.

‘That’s why it’s important to spot the differences, so any lung cancer diagnosis can be made as early as possible and not mistaken for COVID-19,’ says the Roy Castle Lung Cancer Foundation.

What’s new?

The UK Lung Cancer Clinical Expert Group (CEG) and Roy Castle Lung Cancer Foundation published a new infographic on differentiating between symptoms of COVID-19 and lung cancer.

Despite some symptoms being the same, the chart outlines important differences in the two presentations. While a cough, breathlessness and fatigue are all symptoms of acute onset for COVID-19 patients, those with lung cancer are more likely to have an unexplained, persistent cough and breathlessness, while fatigue will have been present for four weeks or more, says the guidance.

The infographic also highlights red flag symptoms for COVID-19, including fever, loss of smell and taste, muscle pain, and initial flu-like signs.

Red flags for lung cancer include coughing up blood, chest pain, weight and appetite loss, swollen nodes in the neck and finger clubbing. Lung cancer risk factors of smoking, age and exposure to asbestos should also be considered. Indeterminate features are also listed, such as difficulty taking a deep breath, recurrent chest infections and chest tightness.

Actions are suggested for each scenario. Patients with suspected lung cancer should be swabbed for COVID-19, with those testing positive treated according to current guidance then reviewed after two weeks. Those with a negative test should be referred for a chest X-ray, or directly to the lung cancer service for a computerised tomography (CT) scan and triage, following the national optimal lung cancer pathway.

How you can help your patient

Respiratory-related symptoms which have persisted beyond three weeks should be investigated as a possible serious disease, including lung cancer, rather than treated as an acute infection, says CRUK.

Remind patients that seeking healthcare is a valid and permitted reason to leave their home during the pandemic. Reassure them that safety precautions are in place in secondary care for any follow-up investigations or referrals, such as chest X-rays or CT scans.

Expert comment

Mark Foulkes, president elect of UK Oncology Nursing Society and a Macmillan lead cancer nurse and nurse consultant (acute oncology) at the Royal Berkshire NHS Foundation Trust

Mark Foulkes, president elect of UK Oncology Nursing Society and a Macmillan lead cancer nurse and nurse consultant (acute oncology) at the Royal Berkshire NHS Foundation Trust

‘This is a useful resource for nurses. Those of us working in oncology are often asked about the difference between a COVID-19 and lung cancer presentation. Queries can come from our patients, including those who are on chemotherapy who can be more prone to chest infections and are worried about the coronavirus. This can help to reassure them.

‘It’s also useful for those who have recovered from COVID-19 but still have symptoms that they attribute back to it, including a persistent cough. This guides them towards seeking further help to get their symptoms checked out.

‘It’s also a good tool for those colleagues who work in general practice, primary care and emergency departments. It’s something we can point them towards for clear guidance and advice.’

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