Management and survival of patients with lung cancer in Scotland diagnosedin 1995: results of a national population based study

Background-The prognosis of patients with lung cancer in Scotland is poor a nd not improving. This study was designed to document factors influencing r eferral, diagnostic evaluation, treatment, and survival in patients with lu ng cancer. Methods-Patients diagnosed during 1995 were identified from the Scottish Ca ncer Registry and their medical records were reviewed. Adequate records wer e available in 91.2% of all potentially eligible cases. Results-In 1995, patients in Scotland with lung cancer had a high rate of m icroscopic verification (74.1%) and 75.3% were assessed by a respiratory ph ysician; however, only 56.8% received active treatment (resection 10.7%, ra diotherapy 35.8%, chemotherapy 16.1%) and 2.9% participated in a clinical t rial. Survival was poor with a median of 3.6 months; 21.1% (95% CI 19.8% to 22.4%) were alive at I year and 7.0% (95% CI 6.2% to 7.8%) at 3 years. Man agement by respiratory physician, oncologist, or thoracic surgeon was an in dependent predictor of access to potentially curative treatment and better survival. Conclusion-This national population based study demonstrates low use of tre atment, poor survival, and the influence of process of care on survival, Im plementation of evidence-based guidelines will require substantial changes in practice. Increasing the number of patients who receive treatment may im prove survival.