Cancer Keys: Persistent Cough – Think COVID-19, Think Cancer

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Potential pitfall:

There has been a significant reduction in suspected cancer referrals during the COVID-19 crisis. Yet, lung cancer is a major cause of premature death in the UK. Clinician’s must identify those at risk of lung cancer and investigate when appropriate, to ensure we do not miss opportunities for early diagnosis and curative treatment.

Helpful hint:

Consider this guidance when selecting patients for a chest X-ray or a suspected lung cancer referral during coronavirus, if a patient presents with a persistent cough > 3 weeks and:

  • Smoking history >20 pack years
  • Lack of additional coronavirus symptoms (fever, myalgia, coronavirus contact)
  • Other risk factors for lung cancer (family history, asbestos exposure)
  • Associated red flag symptoms (hoarse voice, weight loss, chest pain, new persistent breathlessness)

NICE guidelines recommend offering an urgent chest X-ray (to be performed within 2 weeks) to assess for lung cancer in people aged 40 and over, who have ever smoked and present with a cough; or are aged 40 and over who present with a cough and another red flag symptom, or a persistent or recurrent chest infection. Refer using a suspected cancer pathway referral (for an appointment within 2 weeks) if they are aged 40 and over with unexplained haemoptysis, or their chest X-ray suggests lung cancer.


Dr Matthew Evison, Consultant Chest Physician and Clinical Lead, Director of the Lung Pathway Board and clinical lead for the CURE project for Greater Manchester

Kennedy et al.  Lung cancer stage-shift following a symptom awareness campaign. Thorax. 2018 Dec;73(12):1128-1136

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Read NICE’s guidance here

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