Variation in comorbidity and clinical management in patients newly diagnosed with lung cancer in four Scottish centers.

BACKGROUND: Treatment and survival rates within Scotland for patients with lung cancer seem lower than in many other European countries. No study of lung cancer has attempted to specifically investigate the association between variation in investigation, comorbidity, and treatment and outcome between different centers. METHODS: Patient demographics, World Health Organization/Eastern Cooperative Oncology Group performance status, and primary treatment modality were recorded. In addition to recording the comorbidities present in each patient, the severity of each comorbidity was graded on a 4-point scale (0-3) using validated severity scales. Data were collected as the patient was investigated and entered in an anonymized format into a database designed for the study. RESULTS: Prospectively collected data from 882 patients diagnosed with lung cancer in four Scottish centers. A number of statistically significant differences were identified between centers. These included investigation, treatment between centers (i.e., surgical rates), age, tumor histology, smoking history, socioeconomic profile, ventilatory function, and performance status. Predictors of declining performance status included increasing severity of a number of comorbidities, age, lower socioeconomic status, and specific centers. CONCLUSIONS: This study has identified many significant intercenter differences within Scotland. We believe this to be the first study to identify nontumor factors independent of performance status that together limit the ability to deliver radical, possibly curative, therapy to our lung cancer population. It is only by identifying such factors that we can hope to improve on the relatively poor outlook for the majority of Scottish patients with lung cancer.

Fighting lung cancer in the developed world--a model of care in a UK hospital.

OBJECTIVES: To highlight the initial management approach for Lung Cancer in a UK Hospital with the aim of translating the principles of such methodology to a developing country, such as Pakistan. METHODS: A descriptive observational study was carried out at Stobhill Hospital, Glasgow, UK. The investigator (IMB) observed the Lung Cancer Service, attending the weekly 'New patients Clinic', 'Results Clinic', and 'Multidisciplinary team (MDT) meetings'. The process observations and the factual data describing the details of the service were recorded on a pre-designed pro-forma. Observations relating to two aspects of this service (Results Clinic and MDT) are included in this report. RESULTS: The methodology of communicating results of lung cancer investigations to patients in a pre-planned and staged manner at a dedicated 'Results Clinic' was identified as a useful approach. A format of communication was consistently followed. CONCLUSION: The MDT consisted of a Respiratory Physician, Clinical Oncologist, Thoracic Surgeon, Radiologist, Pathologist and Palliative Care Specialist. Each patient's case was discussed on an individual basis and the team developed a consensus regarding diagnosis, staging of the disease, further need for diagnostic procedures and treatment options, bearing in mind the patient's performance status, co-morbidity and their wishes. This approach has improved the initial part of the lung cancer patient journey and components of this approach could easily be transferred to a developing country.

Metastases to breast from primary lung cancer.

Metastatic disease to the breast from extra mammary sites is uncommon and has an incidence of 0.5 to 3%. It is important to make an accurate diagnosis as this has an impact on the therapeutic planning and management. Clinically, it can be difficult to differentiate between primary breast cancer and a metastatic disease. An incorrect diagnosis can lead to unnecessary surgical interventions. Immunohistochemistry has a significant role in identifying the primary origin of tumor and has to be considered in the presence of unusual cytologic patterns. We report three cases of metastatic disease to breast from primary lung tumors. The cases demonstrate the difficulties encountered in the diagnosis and the impact on the management of these patients.