Patterns of Care and Survival in Non Small Cell Lung Cancer: 15 Years’ Experience in a General Hospital

Socio-economic status and patterns of care in lung cancer

OBJECTIVE

This retrospective study aims to explore the associations between socio-economic factors and lung cancer management and outcomes in the Australian setting.

METHODS

The study population consisted of patients who were living in the Northern Sydney Area Health Service (NSAHS) or South Western Sydney Area Health Service (SWSAHS) at the time of their lung cancer diagnosis in 1996. Data on patient demographics, tumour characteristics, management details, recurrence and survival were collected and compared between the two areas. Socio-economic status indicators of the two Area Health Services were obtained from the Australian Bureau of Statistics.

RESULTS

There were 270 and 256 new cases of lung cancer identified in NSAHS and SWSAHS respectively. Patients in NSAHS were slightly older and there were more women. Based on the 1996 Census data, the population of NSAHS is more affluent, better educated and more likely to be employed compared with SWSAHS. The stage distributions and performance status of the two areas were similar. The utilisation rates of different treatment modalities in the two areas were similar except for chemotherapy. The five-year overall survival rate was 10.5% in NSAHS and 7.2% in SWSAHS (p=0.08). Comparison based on the SEIFA Index of Relative Socio-economic Disadvantage did not reveal significant differences.

CONCLUSION

Patients with lung cancer had similar patterns of care and survival despite differences in socio-economic profiles between the two Area Health Services.

IMPLICATION

There seems to be equity of access to lung cancer services between the two Area Health Services.

Trends in incidence and prognosis of the histological subtypes of lung cancer in North America, Australia, New Zealand and Europe

BACKGROUND

Since the incidence of the histological subtypes of lung cancer in industrialised countries has changed dramatically over the last two decades, we reviewed trends in the incidence and prognosis in North America, Australia, New Zealand and Europe, according to period of diagnosis and birth cohort and summarized explanations for changes in mortality.

METHODS

Review of the literature based on a computerised search (Medline database 1966-2000).

RESULTS

Although the incidence of lung cancer has been decreasing since the 1970s/1980s among men in North America, Australia, New Zealand and north-western Europe, the age-adjusted rate continues to increase among women in these countries, and among both men and women in southern and eastern Europe. These trends followed changes in smoking behaviour. The proportion of adenocarcinoma has been increasing over time; the most likely explanation is the shift to low-tar filter cigarettes during the 1960s and 1970s. Despite improvement in both the diagnosis and treatment, the overall prognosis for patients with non-small-cell lung cancer hardly improved over time. In contrast, the introduction and improvement of chemotherapy since the 1970s gave rise to an improvement in - only short-term (<2 years) - survival for patients with small-cell lung cancer.

CONCLUSIONS

The epidemic of lung cancer is not over yet, especially in southern and eastern Europe. Except for short-term survival of small cell tumours, the prognosis for patients with lung cancer has not improved significantly.

Survey on the treatment of non-small-cell lung cancer in Italy

BACKGROUND

The results of the Italian part of an international survey on therapeutic preferences and opinions about prognosis of patients affected by non-small-cell lung cancer (NSCLC) are shown.

PATIENTS AND METHODS

The investigation was conducted by the means of a postal questionnaire aiming to gather information on preferences about treatment and beliefs about survival of three hypothetical patients affected by NSCLC in different stages (T2N1M0, T2N3M0, M1); three sources of Italian physicians potentially treating patients affected by NSCLC were the target population: participants in the Adjuvant Lung Project Italy (Alpi) trial, a 20% random sample of the Italian Medical Oncology Association (AIOM) and representatives of almost all the pneumology wards in Italy.

RESULTS

Overall, there were 287 evaluable responses, 89% of respondents were males, mean age was 46 years, years from graduation 21 and charge of patients per clinician 82. The most important result is the wide variation of answers both about therapy and prognosis. Expectations about size of prognosis improvement with a new chemotherapy seem to be excessive.

CONCLUSIONS

The results are discussed in relation to the twin surveys of Canada and England and Wales and to the meta-analyses on the efficacy of chemotherapy as an adjunct to primary treatment and on postoperative radiotherapy in non-small-cell lung cancer.

Cell kinetics analysis of surgically resected non-small cell carcinoma of the lung using the AgNOR silver stain

Cell kinetics analysis of lung carcinoma using DNA flow cytometry has shown a significant correlation with the biological behavior of these neoplasms. Ploidy has shown a more significant association with aggressive behavior. The method may however not be available in all centers. Two counts of the AgNOR silver stain have been correlated with ploidy and proliferative activity (PA). The first count, which is the mean number of AgNOR granules (mAgNOR), correlates with ploidy. The second count is the percentage of cells with > 5 AgNORs/nucleus (pAgNOR), reflects PA. We performed the AgNOR silver stain using the two above-mentioned counts in 41 cases of surgically resected nonâsmall cell carcinoma of the lung. The cases included 14 adenocarcinomas, 24 squamous cell carcinomas, and three undifferentiated nonâsmall cell carcinomas. Follow-up data were available on 36 of the patients, ranging from 10 to 31 months (median 18 months). Thirteen of these patients (36%) developed progressive disease. Adenocarcinomas showed mAgNOR counts suggestive of aneuploidy (> 2.4) in nine of the 14 patients (64%) and 16 of the 24 squamous carcinomas (66%). The adenocarcinomas showed high pAgNOR counts (> 8%) in eight of the 14 cases (57%), in contrast to 15 of the 24 squamous carcinomas (62%). The AgNOR counts did not show any statistically significant correlation with tumor type, grade or stage of disease. The mAgNOR counts were aneuploid in all 13 progressive cases and in only 10 of the 23 stable cases (43%)(P=0.001). The pAgNOR counts were high in 12 of the 13 cases that progressed (92%), in contrast to 10 of the 23 stable cases (43%)(P=0.01). There is no significant evidence that squamous carcinoma of the lung may have a higher incidence of aneuploidy and high PA than adenocarcinoma. Our data also confirm previous data showing that aneuploid lung carcinomas have more aggressive behavior than diploid ones. This study also indicates that, despite the short-term follow-up data, the use of the AgNOR silver stain for cell kinetics analysis of nonâsmall cell carcinoma of the lung may potentially provide useful predictive information on the biologic behavior of lung carcinoma. Long-term follow-up may provide more significant information.