title: Early mortality in lung cancer: French prospective multicentre observational study.
abstract: BACKGROUND
  Despite the progress seen in the last decade in diagnosis and treatment, lung cancer has still a bad prognosis and a substantial number of patients died within the weeks following diagnosis. The objective of this study was to quantify early mortality in lung cancer, to identify patients who are at high risk of early decease, and to describe their management in a real world.
  
  
  METHODS
  Prospective observational study including consecutively all adult patients managed for primary lung cancer histologically or cytologically diagnosed in 2010 in the respiratory medicine department of one of the participating French general hospitals. Patients and cancer characteristics and first therapeutic strategy were collected at diagnosis. Dates of death were obtained from investigators or town council of the patient's birth place. All fatal cases were considered regardless of the cause of the death. Multivariate logistic regression model was used to determine the factors significantly and independently associated with death at 1 and 3 months.
  
  
  RESULTS
  Seven thousand fifty-one patients from 104 centres were included in the study. Vital status was obtained for 6,981 patients. Respectively, 678 (9.7%) and 1,621 (23.2%) of the 6,981 patients with available data died within 1 and 3 months following diagnosis. As compared with the other patients, they were significantly older and frailer (based on performance status [PS] and recent weight loss) and more frequently reported stage IV tumour. Overall, 64.5% (1 month) and 42.8% (3 months) of patients had no cancer therapy and less than 1% were included in a therapeutic trial.
  
  
  CONCLUSIONS
  About one in four patients died within 3 months following lung cancer diagnosis. Early mortality mainly involves frail patients with advanced cancer and is associated with lack of cancer therapy. This supports the need for early diagnosis and clinical trials in this population. Reducing early mortality to give supplementary time to patients to organise the future is a major challenge for 21(st) century physicians.
authors.affiliation: Service de pneumologie, Centre hospitalier, BP 218, 6-8 rue Saint Fiacre, Meaux, 77104 Cedex, France. m-grivaux@chmeaux.fr.
authors.forename: Michel
authors.initials: M
authors.lastname: Grivaux
authors.affiliation: Service de pneumologie, Hôpital Emile Muller, Mulhouse, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Debieuvre
authors.affiliation: Service de pneumologie, Hôpital Pierre Beregovoy, Nevers, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Herman
authors.affiliation: Service de pneumologie, Centre hospitalier, Auxerre, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Lemonnier
authors.affiliation: Service de pneumologie, Centre hospitalier, Libourne, France.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Marcos
authors.affiliation: Service de pneumologie, Hôpital Laënnec , Creil, France.
authors.forename: Jacky
authors.initials: J
authors.lastname: Crequit
authors.affiliation: Service de pneumologie, Hôpital St-Joseph-St-Luc , Lyon, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Vuillermoz-Blas
authors.affiliation: Service de pneumologie, Centre hospitalier, Cahors, France.
authors.forename: Patricia
authors.initials: P
authors.lastname: Barre
authors.affiliation: Service de pneumologie, Centre hospitalier, Nanterre, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Saillour
authors.affiliation: Pneumologie et Pathologies du sommeil, Centre hospitalier Intercommunal Compiègne-Noyon, Compiègne, France.
authors.forename: Francis
authors.initials: F
authors.lastname: Martin
mesh_terms: D000203:Activities of Daily Living; D000230:Adenocarcinoma / Q000401:mortality* / Q000473:pathology; D065311:Adenocarcinoma in Situ / Q000401:mortality / Q000473:pathology; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002276:Carcinoid Tumor / Q000401:mortality* / Q000473:pathology; D018287:Carcinoma, Large Cell / Q000401:mortality* / Q000473:pathology; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000473:pathology; D005260:Female; D016330:Frail Elderly; D005602:France; D006769:Hospitals, General; D006801:Humans; D016015:Logistic Models; D008175:Lung Neoplasms / Q000401:mortality* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011446:Prospective Studies; D012307:Risk Factors; D055752:Small Cell Lung Carcinoma / Q000401:mortality* / Q000473:pathology; D012907:Smoking / Q000453:epidemiology*; D015431:Weight Loss
keywords: Epidemiology; France; Hospital; KBP-2010-CPHG; Lung neoplasms; Mortality