Standard Medical Care or Urgent Chest X-ray in Diagnosing Lung Cancer in Smokers With Chest Symptoms Who Are Older Than 60 Years

OBJECTIVES: Primary * To determine the prevalence of extra-NICE symptoms in patients consulting in UK general practice. * To determine the proportion of patients who agree to participate in the trial. * To determine the proportion of patients who are diagnosed with lung cancer and the best sources of routine data for capturing lung cancers. Secondary * To determine the best way to train general practitioners to identify and recruit eligible patients into the trial. * To determine the most effective method of presenting the trial (and randomization) to patients. * To determine the barriers to recruitment and how to overcome those barriers. * To determine the best tools to use to measure anxiety/depression that may be caused by unnecessary chest-x-rays or no chest x-rays. * To determine the best measures of resource use to facilitate health economic analysis of the cost-effectiveness of 'extra-NICE'. * To determine the stage at diagnosis, performance status, and the proportion of patients receiving radical treatments in those diagnosed with lung cancer. OUTLINE: This is a multicenter study. Patients are randomized to 1 of 2 treatment arms. * Arm A: Patients are managed as per the National Institute for Health and Clinical Excellence (NICE) guidelines. * Arm B: Patients are referred for an urgent chest x-ray according to extra-NICE guidelines. General practitioners from South East Wales are surveyed to assess their level of interest in the proposed full trial. For the feasibility study, 20 South East Wales general practices and 6 South Yorkshire general practices are selected. General practitioners are trained to recruit all patients who fulfill the extra-NICE criteria as well as those who do not. Patients complete questionnaires (HADS, EQ-5D, and ICECAP\[O\]) at baseline and at 2 months to measure quality of life and health economic analysis of the cost-effectiveness of extra-NICE guidelines. Peer Reviewed and Funded or Endorsed by Cancer Research UK.