Promoting help-seeking in response to symptoms amongst primary care patients at high risk of lung cancer: a mixed method study

Background: Lung cancer symptoms are vague and difficult to detect. Interventions are needed to promote early diagnosis, however health services are already pressurised. This study explored symptomology and help-seeking behaviours of primary care patients at ‘high-risk’ of lung cancer (≥50 years old, recent smoking history), to inform targeted interventions. Methods: Mixed method study with patients at eight general practitioner (GP) practices across south England. Study incorporated: postal symptom questionnaire; clinical records review of participant consultation behaviour 12 months pre- and post-questionnaire; qualitative participant interviews (n = 38) with a purposive sample. Results: A small, clinically relevant group (n = 61/908, 6.7%) of primary care patients was identified who, despite reporting potential symptoms of lung cancer in questionnaires, had not consulted a GP ≥12 months. Of nine symptoms associated with lung cancer, 53.4% (629/1172) of total respondents reported ≥1, and 35% (411/1172) reported ≥2. Most participants (77.3%, n = 686/908) had comorbid conditions; 47.8%, (n = 414/908) associated with chest and respiratory symptoms. Participant consulting behaviour significantly increased in the 3-month period following questionnaire completion compared with the previous 3-month period (p = .002), indicating questionnaires impacted upon consulting behaviour. Symptomatic non-consulters were predominantly younger, employed, with higher multiple deprivation scores than their GP practice mean. Of symptomatic non-consulters, 30% (18/61) consulted ≤1 month post-questionnaire, with comorbidities subsequently diagnosed for five participants. Interviews (n = 39) indicated three overarching differences between the views of consulting and non-consulting participants: concern over wasting their own as well as GP time; high tolerance threshold for symptoms; a greater tendency to self-manage symptoms. Conclusions: This first study to examine symptoms and consulting behaviour amongst a primary care population at ‘high- risk’ of lung cancer, found symptomatic patients who rarely consult GPs, might respond to a targeted symptom elicitation intervention. Such GP-based interventions may promote early diagnosis of lung cancer or other comorbidities, without burdening already pressurised services

Immediate chest X-ray for patients at risk of lung cancer presenting in primary care: randomised controlled feasibility trial

Background: Achieving earlier stage diagnosis is one option for improving lung cancer outcomes in the United Kingdom. Patients with lung cancer typically present with symptoms to general practitioners several times before referral or investigation. Methods: We undertook a mixed methods feasibility individually randomised controlled trial (the ELCID trial) to assess the feasibility and inform the design of a definitive, fully powered, UK-wide, Phase III trial of lowering the threshold for urgent investigation of suspected lung cancer. Patients over 60, with a smoking history, presenting with new chest symptoms to primary care, were eligible to be randomised to intervention (urgent chest X-ray) or usual care. Results: The trial design and materials were acceptable to GPs and patients. We randomised 255 patients from 22 practices, although the proportion of eligible patients who participated was lower than expected. Survey responses (89%), and the fidelity of the intervention (82% patients X-rayed within 3 weeks) were good. There was slightly higher anxiety and depression in the control arm in participants aged >75. Three patients (1.2%) were diagnosed with lung cancer. Conclusions: We have demonstrated the feasibility of individually randomising patients at higher risk of lung cancer, to a trial offering urgent investigation or usual care

A comparative overview of antioxidative properties and phenolic profiles of different fungal origins: fruiting bodies and submerged cultures of Coprinus comatus and Coprinellus truncorum

Bioactive properties of fungi considerably differ between the fruiting body (FB) and the submerged culture as regards mycelia (M) and the fermentation broth (F). Antioxidant properties of hot-water extracts obtained from three different fungal origins: FB, M and F of two autochthonous fungal species (Northern Serbia), Coprinus comatus and Coprinellus truncorum were investigated. Free radical scavenging capacity (RSC) was evaluated in vitro by the DPPH assay and reducing power ability (FRAP assay). Considering possible bioactive properties of different compounds present in fungal extracts, the content of total proteins (TP), phenols (TC) and flavonoids (TF) were investigated colorimetrically. The chemical characterisation of the examined extracts was evaluated using the HPLC–MS/MS method. C. comatus showed the strongest RSC activity; more precisely, fermentation broth extract (FCc) on DPPH radicals (IC50 = 5.06 μg mL(−1)) and fruiting body extract (FBCc) for the FRAP assay (42.86 mg ascorbic acid equivalents (AAE)/g). Submerged M extract of both species showed the highest TC (MCc 81.95 mg gallic acid eq (GAE)/g d.w.; MCt 81.64 mg GAE/g d.w.), while FB extracts contained the highest content of TP. Comparing LC–MS phenolic profiles between species—interspecifically and among different fungal origins—intraspecifically (fruiting bodies and submerged cultures), high variations were noticed. In submerged M or F extracts of C. comatus, vanillic, gallic, gentisic and cinnamic acids were detected, as opposed to FB. Considering that diverse phenolic profiles of detected antioxidant compounds were obtained by submerged cultivation, this type of cultivation is promising for the production of antioxidant substances