PATTERNS OF CARE AND SURVIVAL IN NONSMALL CELL LUNG-CANCER - 15 YEARSEXPERIENCE IN A GENERAL-HOSPITAL

Background: Transferring results derived from clinical research into p ractice is particularly difficult in lung cancer where clear indicatio ns for treatment are defined only for selected subgroups of patients. Studies on hospital-based lung cancer population could provide data fo r quantifying this issue- Patients and methods: This was a follow-up s tudy of consecutive, first-diagnosis cases referred to the in-and outp atient cancer clinics of a large italian general hospital between Janu ary 1975 and December 1990. Data were collected from medical records a nd recorded on ad hoc standardized forms. Analysis focused on changes in distribution over time of patient-related characteristics, prevalen ce of specific treatment strategies and survival of the study populati on, Results: 1345 primary non small cell lung cancer cases were review ed and 1125 were fully evaluable. In early stages (510/1125, 45%) only 237 patients actually underwent surgery. In this group surgery increa sed from 36 to 69% whereas chemotherapy decreased from 58 to 15%. In t he advanced group (615/1125, 55%) chemotherapy was the preferred treat ment but combined modalities tripled over time (from 4 to 12%). No sig nificant changes in survival were observed within each group over time . Conclusion: Despite changes in the therapeutic approaches, mortality from lung cancer does not seem reduced over time. Since the proportio n of cases that could potentially benefit from ''active'' treatments i s small, for the large majority of patients a switch in clinical resea rch from a cure to a careoriented strategy should be considered.