Lung cancer in Victoria: are we making progress?
OBJECTIVE
To identify areas to improve patient management in lung cancer, which remains the greatest cause of death from cancer in Australia.


METHODS
Retrospective survey of all cases of lung cancer reported to the Victorian Cancer Registry from 1 January to 30 June 2003 and followed up for 5 years.


METHODS
Patient and disease characteristics, investigations, staging, treatment, cause of death, survival.


RESULTS
841 patients were included. Smoking data were available for 799, of whom 63 (7.9%) had never smoked. Of 655 non-small cell lung cancer (NSCLC) cases, 198 (30.2%) were treated with curative intent, 125 (19.1%) by surgery and 73 (11.1%) by radiotherapy with or without chemotherapy. Only 7 (6.9%) of surgical patients with complete R0 resection had adjuvant chemotherapy. Of 101 small cell lung cancer (SCLC) cases, a third had limited stage disease which was mostly treated with curative intent by chemotherapy with or without radiotherapy. Patients whose cases were discussed at a multidisciplinary meeting (MDM) were significantly more likely to receive anticancer treatment and had longer survival; on multivariate analysis, MDM discussion was an independent prognostic factor. Compared with a similar survey 10 years earlier, the median age of patients diagnosed with lung cancer had increased by almost 3 years, the proportion of affected men decreased and adenocarcinoma was more frequent, while 10% of patients continued to have no pathologically confirmed diagnosis and 26% continued to receive no anticancer treatment. The number of patients with NSCLC who went on to a definitive surgical procedure fell with no detriment to survival, which likely reflected better staging with the introduction of positron emission tomography scanning.


CONCLUSIONS
Opportunities to improve patient management included increasing the proportion with a pathologically confirmed diagnosis and greater use of postsurgical adjuvant chemotherapy. A high proportion of patients received no treatment, with underuse of chemotherapy and radiotherapy. Critically, the low rate of case discussions at MDMs needs to increase. However, effective strategies are required to identify cases early, as over two-thirds currently present with incurable disease.
Olivia Newton-John Cancer and Wellness Centre, Austin Health, Melbourne, VIC, Australia. paul.mitchell@austin.org.au.
Paul L R
PL
Mitchell
Vicky J
VJ
Thursfield
David L
DL
Ball
Gary E
GE
Richardson
Louis B
LB
Irving
Yvonne
Y
Torn-Broers
Graham G
GG
Giles
Gavin M
GM
Wright
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D019538:Health Care Surveys; D006306:Health Surveys; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D055752:Small Cell Lung Carcinoma / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology; D014739:Victoria / Q000453:epidemiology