What is the evidence for delayed presentation in primary care among smokers? A systematic review.

Talk Code: 
Annie Hendry
RD Neal, J Hiscock
Author institutions: 
North Wales Centre for Primary Care Research, Bangor University


Lung cancer is responsible for the greatest number of cancer deaths in Wales, accounting for 22% overall. As almost all cases of lung cancer are attributable to smoking, smokers are at a significant risk for developing the disease. Some evidence has been shown that delays in diagnosis can seriously influence the operability of lung cancer and patients are often inoperable at the time of diagnosis. Some evidence has indicated that smokers may hesitate to consult their GP and this review aimed to determine whether patient delays are greater in smokers than non-smokers.


A systematic review of the literature was conducted following PRISMA guidelines. Electronic databases were searched using thesaurus terms relating to smoking, primary care, and presentation in order to achieve research objectives.


Five studies were included in the narrative synthesis. Publication dates ranged between 2002 and 2014. All included studies utilised survey data collected either by post, telephone, or through interview surveys. Participants were adults aged over 18 and all studies included both male and female participants. All results showed that patient delays and non-consulting were more common in smokers than non-smokers. Individuals without a regular doctor and with infrequent physical and dental check-ups were more likely to be current smokers. Current smokers were also less likely to have made health care benefit claims for primary care services than never smokers. It was also reported that individuals with more unhealthy lifestyles were more likely to spend twelve months without seeing their GP, among those who did seek primary healthcare, those with unhealthy lifestyles consulted on fewer occasions. In one study 8.8% of smokers reported not having seen a GP within the last twelve months compared with 7.8% of non-smokers. Current and ex-smokers were also less likely to consult their GP for high impact symptoms including chest pain and haemoptysis. Increasing pack years of smoking were independently associated with increased time to presentation.


The results show that smokers are less likely to use primary care services than non-smokers. Among those who do use primary care, presentation is less frequent in smokers and ex-smokers than never smokers. Due to the relationship between smoking and lung cancer and the potential benefits of earlier diagnosis, further research is needed in order to discover reasons for less frequent use of primary care in order to encourage timely presentation of symptoms and improve clinical outcomes.

Submitted by: 
Annie Hendry
Funding acknowledgement: 
Health and Care Research Wales