Efforts to reduce delays in lung cancer management should not cease even though they may not affect the prognosis

It is universally acknowledged that the prognosis of lung cancer is very poor, with overall 5 year survival figures of about 5–10% worldwide.1 What is less well recognised is that the picture has changed very little over the last 20 years, and that this is in sharp distinction to other solid tumours where not only are survival rates better—in the order of 60–90%—but they have been increasing (improving) fairly rapidly and continue to do so over a comparable time. For example, in our region of the UK, comprehensive population based registry data for 2 year survival of the 5000 patients diagnosed with lung cancer in 1999 was 13% compared with 60%, 79%, 87% and 92% for colorectal, cervix, prostate, and breast cancer, respectively.2 There is merit therefore in considering what might influence and be responsible for this poor outcome.

The factors which affect the prognosis in lung cancer are principally the stage and related performance status at presentation, histology (that is, the biological activity of the tumour), co-morbidity, age, sex, and the time interval between first symptom and treatment.

Some of these factors are not modifiable. In theory, however, reducing intervals between presentation and treatment might downstage patients and allow an improvement in survival. There are excellent data to show that early stage disease has better survival;3 there is less good but nevertheless fairly convincing evidence that very early stage disease (that is, small asymptomatic lesions) have an even better prognosis.

There are, of course, other ways of reducing lung cancer mortality. In the very long term, over a period of decades, prevention is clearly key. In the longer term, over a 5–10 year time span, the identification …

https://thorax.bmj.com/content/thoraxjnl/59/1/1.1.full.pdf

Delays in managing lung cancer

Noninvasive Staging of Non-small Cell Lung Cancer*: A Review of the Current Evidence

A collaboration of multidisciplinary experts on the functional evaluation of lung cancer patients has been facilitated by the European Respiratory Society (ERS) and the European Society of Thoracic Surgery (ESTS), in order to draw up recommendations and provide clinicians with clear, up-to-date guidelines on fitness for surgery and chemo-radiotherapy. The subject was divided into different topics, which were then assigned to at least two experts. The authors searched the literature according to their own strategies, with no central literature review being performed. The draft reports written by the experts on each topic were reviewed, discussed and voted on by the entire expert panel. The evidence supporting each recommendation was summarised, and graded as described by the Scottish Intercollegiate Guidelines Network Grading Review Group. Clinical practice guidelines were generated and finalized in a functional algorithm for risk stratification of the lung resection candidates, emphasising cardiological evaluation, forced expiratory volume in 1 s, systematic carbon monoxide lung diffusion capacity and exercise testing. Contrary to lung resection, for which the scientific evidences are more robust, we were unable to recommend any specific test, cut-off value, or algorithm before chemo-radiotherapy due to the lack of data. We recommend that lung cancer patients should be managed in specialised settings by multidisciplinary teams.

https://erj.ersjournals.com/content/erj/34/1/17.full.pdf

ERS/ESTS clinical guidelines on fitness for radical therapy in lung cancer patients (surgery and chemo-radiotherapy)

Ers/ests clinical guidelines on fitness for radical therapy in lung cancer patients (surgery and chemo-radiotherapy) . a. brunelli, a. charloux, c.t. bolliger, g. rocco, j-p. sculier, g. varela

Noninvasive Staging of Non-small Cell Lung Cancer: ACCP Evidenced-Based Clinical Practice Guidelines (2nd Edition)

Writing Group: Professor P Armstrong (Imaging), Dr J Congleton,* Mr S W Fountain (Chairman),* Dr T Jagoe, Dr D F McAuley,* Dr J MacMahon,* Dr M F Muers,* Mr R D Page,* Dr P K Plant,* Dr M Roland, Dr R M Rudd, Mr W S Walker,* Dr T J Williams*. Specialist advisors: Professor M I Saunders (Royal College of Radiologists), Dr A G Nicholson (Royal College of Pathologists). *Members of the core Writing Group.

/pdf/guidelines-on-the-selection-of-patients-with-lung-cancer-3mztx2f3l5.pdf

W Ireland

Papers

Guidelines on the selection of patients with lung cancer forsurgery