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Differentiation of the coughs – cancer or covid-19?

Written by | 17 Sep 2020 | 'In Discussion With'

Interview and article by Christine Clark

Differentiation of the Cs is a document aimed at health care professionals working in primary care to help them to triage their patients.  It provides a simple table that lists the signs and gives specific guidance on the action required, explains Professor David Baldwin, chairman of the lung cancer CEG.  

Differentiation of the Cs separates patients into three different groups according to their signs and symptoms. The first is people with classic symptoms of covid-19 and these should be managed according to current guidance. The other clear-cut group is those with classic symptoms of lung cancer. These are patients who do not have any covid-specific symptoms, but have symptoms more suggestive of lung cancer, such as a chronic cough and associated shortness of breath together with other symptoms and risk factors listed in the NICE guideline.

Probably the most important is the intermediate group where patients have symptoms that could fit with either covid-19 or lung cancer.  People in the intermediate group should be asked to self-isolate for 14 days, as per covid guidance, and to have nasal/oropharyngeal swab for SARSCoV-2 PCR. If the swab result is negative and symptoms persist then the patient should be referred to the lung cancer service in the normal way.  Patients in the suspected cancer group should also have swabs taken for SARSCoV-2 PCR. People should not be sent for CT scans without first excluding possibility of covid, emphasises Professor Baldwin.

Differentiation of the Cs is the first document that has been really specific about how to differentiate between the coughs of covid-19 and lung cancer. The document is brief and lists the signs and symptoms and the action required. Early feedback from a number of cancer alliances suggests that the document is useful in practice, he says. “We need to ensure that this document is widely available so that people can use it”, he adds. 

Di­fferentiation of the Cs in Lung Cancer: Cancer vs COVID-19 can be found at:  


Read and watch the full series on our website or on YouTube

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