Surgeons' assessment of symptoms suggesting extrathoracic metastases in patients with lung cancer. Canadian Lung Oncology Group.
BACKGROUND
In patients with apparently operable non-small cell lung cancer (NSCLC), clinicians often omit investigation for M disease in asymptomatic patients. Previous investigations have not specified in detail what is meant by "symptomatic," and this could differ between surgeons. We have investigated the extent to which surgeons' criteria differ for presence of symptoms.


METHODS
Participating surgeons from seven centers, enrolled patients they judged "asymptomatic" in a randomized trial of investigational strategies for NSCLC. Patients completed a structured questionnaire describing symptoms of the central nervous system (CNS). In 685 patients, we documented CNS symptom recurrence after resectional surgery over 1 year of follow-up.


RESULTS
Two centers enrolled only patients without even the mildest symptoms. Three centers took an intermediate approach, occasionally classifying patients with mild symptoms as "asymptomatic" and thus enrolling them in the trial. Two centers classified an appreciable number of patients with minimal symptoms, and occasionally with more than minimal symptoms, as "asymptomatic." Patients with even mild CNS symptoms were more likely to subsequently present with CNS metastases.


CONCLUSIONS
Thoracic surgeons differ in their ideas of what may constitute the symptoms of M disease. Patients with structured questionnaire results that suggest symptoms of CNS disease are more likely to have CNS symptom recurrence after resectional surgery.
Guyatt
G H
GH
Department of Clinical Epidemiology and Biostatistics, McMaster University Health Sciences Center, Hamilton, ON, Canada.
Cook
D J
DJ
Griffith
L E
LE
Miller
J D
JD
Todd
T R
TR
Johnston
M R
MR
Winton
T L
TL
Casson
A G
AG
Inculet
R I
RI
Darling
G E
GE
Finley
R J
RJ
Deslauriers
J
J
D001859:Bone Neoplasms / Q000175:diagnosis / Q000556:secondary* / Q000601:surgery; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis / Q000556:secondary* / Q000601:surgery; D016543:Central Nervous System Neoplasms / Q000175:diagnosis / Q000556:secondary* / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000601:surgery; D009460:Neurologic Examination / Q000706:statistics & numerical data; D015588:Observer Variation; D018579:Patient Selection