Could Lung Cancer Cases Be Mistaken for COVID-19?

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When Helen began coughing up phlegm in January she thought she just had a chest infection. She was given antibiotics in February and it was only when the cough returned in March and she fell seriously ill, that the 46-year-old from Rugby, and her husband, became concerned. “We thought then I had either got the chest infection back or COVID,” she said.

She was prescribed more antibiotics, but was recommended to avoid attending hospital for an X-ray because of the pandemic. “It was really horrific. My husband would stay awake and watch me breathe,” she said. Helen’s condition worsened. Her cough continued, accompanied by other problems, including wheezing, breathlessness, and fatigue and Helen began to think she might have “long COVID”.

But it was X-rays and scans in July, once she had started coughing up blood, that delivered a shock: Helen had a tumor in her lungs. She went straight to surgery, which confirmed she had a slow-growing lung cancer.

Helen’s story is not unique. Now charities and specialists have raised concerns that people may be mistaking the symptoms of lung cancer, such as a longstanding cough, breathlessness, and unexplained tiredness, for coronavirus, leading to delays in diagnosis and treatment.

According to Cancer Research UK, around 47,800 people are diagnosed with lung cancer in the UK every year. But referrals for suspected lung cancer plummeted during lockdown and were still only 60% of pre-COVID levels by the end of August.

“It’s thought that initial advice for people to stay at home and isolate if they had a new, continuous cough could have led to some people delaying seeking help,” CRUK has warned.

“It is a problem,” said Dr. David Gilligan, consultant clinical oncologist at Addenbrooke’s and Papworth hospitals in Cambridge, and a trustee of the Roy Castle Lung Cancer Foundation.

“Because COVID has now been around for about nine months, we are seeing the consequences of that – of people who are being diagnosed with lung cancer who originally thought that they either might have COVID, or were trying to seek medical attention during the initial lockdown period and it was difficult for them to access normal medical services,” he said, adding that during lockdown people may have been frightened to visit healthcare settings.

“The number of early lung cancers has decreased – we are seeing quite a bit more late-stage cancer – so we have to assume that the delay in diagnosis due to COVID has played a part in that,” said Gilligan.

Early diagnosis is crucial. According to CRUK, 88% of patients diagnosed at the earliest stage of cancer survive for at least one year, compared with just 19% of patients diagnosed at the latest stage.

Dr. Nick Hopkinson, medical director at the British Lung Foundation said it was not clear why referral rates for lung cancer were still low – but said it was likely to be down to factors such as people being concerned about “making a fuss”, noting a survey in July found 44% of GPs said fewer people were seeking medical attention for coughs or breathing problems.

Now the Roy Castle Foundation has launched an information campaign, called Still Here, to highlight the symptoms of lung cancer and encourage people to contact their GP if they have concerns. Campaigns to emphasize the importance of acting on symptoms of all types of cancer have been launched by other charities, including CRUK.

“All cancers have felt the devastation of the pandemic, but lung cancer faces an additional obstacle given that one of its most common symptoms – a persistent cough – is so often linked to COVID-19,” said Paula Chadwick, chief executive of the Roy Castle Foundation.

Helen has now had treatment for her lung cancer and is recovering well. She says she still does not know if she has had COVID, but believes the pandemic could have delayed her diagnosis, with COVID restrictions meaning she was not fully aware of how limiting her illness had become, and the disease itself causing confusion.

“If it wasn’t for COVID I would probably have been more forceful at the doctor’s,” she said. “They mentioned things like COVID anxiety to me and I started to question my own mind.”

While Helen praised the NHS staff, she hopes others will take heed. “Don’t self-diagnose, and keep pushing for an answer,” she said.

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