Influence of delays in diagnosis and treatment on survival in small cell lung cancer patients.

The purpose of this study was to evaluate the influence on survival of delays in the diagnosis and treatment in an unselected population of small cell lung (SCLC) patients. Demographic and disease data of 3,479 SCLC patients were registered in the National Tuberculosis and Lung Diseases Research Institute in Warsaw, Poland during 1995-1998. In 50 % of patients, treatment started within 78 days from the appearance of first symptom(s). The median delay was 30 days (mean 47 days) and the median referral delay to a specialist was 19 days (mean 36 days). Half of SCLC patients were diagnosed during 34 days (mean 55 days). The mean time elapse from the diagnosis to the onset of therapy was 30 days (median 6 days). The multivariate analysis revealed that male gender-HR (hazard ratio = 1.2), ECOG Performance Status of 2 (HR = 1.5) and 3 + 4 (HR = 2.4), and clinical stage III (HR = 1.3) and IV (HR = 1.9) of the disease were independent negative predictors of survival. The patients treated with surgery and combined modality treatment had a better prognosis than those treated with chemoradiotherapy (HR = 1.6), chemotherapy (HR = 2.5), symptomatically (HR = 4.0), or those who refused therapy (HR = 3.9). The delay in the diagnosis and treatment had no effect on survival. Interestingly, patients who were diagnosed faster (below 42 days) actually had a worse prognosis than those diagnosed later. We conclude that a prolonged workup of SCLC patients and an extended time for treatment onset have a positive influence on survival, which may likely have to do with the determination of disease stage and more targeted treatment.

Lung cancer in women: age, smoking, histology, performance status, stage, initial treatment and survival. Population-based study of 20 561 cases.

BACKGROUND: The community-based cancer registry was set up and results were analysed to assess differences in clinicopathological parameters between women and men. PATIENTS AND METHODS: The Pulmonary Outpatient Departments supplied data on 20 561 lung cancer patients diagnosed in Poland from 1995 to 1998. Data regarding demographics, smoking, histology, treatment and survival were obtained. RESULTS: There were 2875 women and 17 686 men with lung cancer. Women were younger than men (60.02 versus 62.18 years; P <0.001). Age <50 years was more frequent in women than in men (23.3% versus 12%; P <0.001). Women with small-cell lung cancer (SCLC) and adenocarcinoma were significantly younger than women with squamous cancer (58.2 and 58.2 versus 61 years; P = 0.05). Also, men with adenocarcinoma and SCLC were younger than men with squamous cancer (60.6 and 60.2 versus 62.3 years; P = 0.05). Squamous cancer was the predominant type of lung cancer both in women (32.5%) and men (55.2%). However, SCLC (26.6% versus 19.9%: P <0.001) and adenocarcinoma (21.6% versus 9.6%; P <0.001) were more frequent in women than in men. Women were more frequently non-smokers than men (18.8% versus 2.4%; P <0.001). Adenocarcinoma patients smoked less intensively than patients with squamous and SCLC both in women (31.4 versus 35.8 and 33.7 packs/year; P <0.02) and in men (38.2 versus 42 and 41.9 packs/year; P <0.002). In multivariate analysis, bad performance status, advanced stage, non-surgical treatment, age >50 years at diagnosis and male gender were significant independent negative prognostic factors. CONCLUSIONS: Lung cancer was six times more frequent in men than in women. Women with lung cancer were younger than men and smoked less intensively. Over-representation of adenocarcinoma and SCLC was observed in the women. Women with lung cancer had a better prognosis than men.

Lung cancer in patients under 50 years old.

PURPOSE: The community based lung cancer registry was set up and the results were analysed to assess the differences in clinicopathological parameters and survival between patients under and over 50 years of age. PATIENTS AND METHODS: The Pulmonary Outpatient Clinics supplied the data on 5404 lung cancer patients diagnosed in Poland in 1995. Data regarding demographic, smoking, histology, clinical stage, performance status, family history of cancer, therapy and survival were obtained. RESULTS: At time of diagnosis 757 (14%) patients were under 50 years of age. In this group the frequency of females was higher as compared to this in the group of older patients (24.2% vs. 12.1%; P<0.001). Also the incidence of adenocarcinoma (12.6% vs. 7.6%; P<0.001) and small cell lung cancer (22.9% vs. 14.8%; P<0.001) were significantly higher in younger patients. Young patients had better performance status (55.4% vs. 46.6%; P<0.001) than old. The incidence of cancer in families of younger patients was higher both among the mothers (4.7% vs. 3.0%; P<0.001) and among the fathers (7.6% vs. 4.1%, P<0.001). Surgery or chemotherapy were more often applied to patients under 50 years in comparison to older ones (P<0.001). Young patients had better prognosis. Higher percentage of them survived one year (32.6% vs. 28.9%; P<0.049). In multivariate analysis, age over 50 at diagnosis, male gender, diagnosis of small cell lung cancer, advanced stage of the disease, bad performance status, and non-surgical therapy were independent negative prognostic factors. CONCLUSION: Among young patients, overrepresentation of women, subjects with positive family history of cancer, with better performance status, with adenocarcinoma and small cell lung cancer were noticed. Young patients were treated more aggressively and had better prognosis than patients over 50 years of age.

[Lung cancer--diagnosis and therapy delay]. / Rak pluca. Opóznienia w procesie diagnostyczno--leczniczym.

UNLABELLED: It is commonly known that in the course of neoplastic disease a diagnosis and therapy should be perform as fast as possible. It is particularly important for lung cancer patients. The goal of this study was to assess the diagnosis and therapy delay in unselected group of lung cancer patients, registered in Pulmonary Outpatients Clinics in all parts of Poland. MATERIAL: 20,561 lung cancer patients were registered in Pulmonary Outpatients Clinics in all parts of Poland from 1995 to 1998. RESULTS: The median delay caused by patients was about 46 days. In 33 provinces symptoms of the disease preceded diagnosis 28 to 50 days and in other 26 provinces--50 to 75 days. The median delay caused by doctors (time between first visit to the doctor and the date of diagnosis) was 65 days. In 35 provinces it was 30 to 70 days and in other 14 provinces this delay was between 70-111 days. The median time between first visit to the doctor and the beginning of therapy was 84 days. The median time between diagnosis and therapy was 30 days. Because chest physicians were also involved in the diagnosis and treatment of lung cancer patients, so for patients registered in years 1996-1998 the causes of delay connected with the function of this medical speciality were assessed. Median time between first visit to the doctor and first visit to the chest specialist was 38 days. Median delay to bronchoscopy was 26 days and to the diagnosis 46 days. CONCLUSION: Delay of diagnosis and therapy vary widely among different provinces of Poland. The delay generated by family doctors and chest physicians are very important and require a deeper evaluation on the province level in the future.

[Lung cancer--differences of incidence between the sexes]. / Rak pluca--róznice w zachorowaniach zwiazane z plcia.

During the last decade increasing incidence of lung cancer among women have been observed in Poland. The aim of the study was to demonstrate differences among men and women with lung cancer. Lung cancer was diagnosed in 785 female and 4619 male in 1995 in Pulmonary Outpatients Departments. Women were younger than man when all histologic types of lung cancer were analysed (59.7 vs 61.9 years p. < 0.001). Particularly younger subjects were those with adenocarcinoma and small cell lung cancer (56.9 and 57.4 years for women and for men respectively 60.2 and 59.6 years, p < 0.001). Although squamous lung cancer was the most prevalent histological type among men (43.7%) and women (24.7%), about two times higher percentage of men had this neoplasm (p. < 0.001). Adenocarcinoma (18% vs 6.6%, p. < 0.001) and small cell lung cancer (18.5% vs 15.5% p. < 0.001) were prevalent in significantly higher percentage among female than male. Nonsmokers were more frequently noticed among women then men (20.4% vs. 1.9%, p. < 0.001), particularly those with adenocarcinoma. Also women smoked less intensively (33.6 pack/years vs. 42.3 pack/years, p < 0.001) except those with squamous cancer. The higher incidence of cancer was observed among mothers (7% vs 3.8% p. < 0.001) and fathers (7.1% vs 5.6%, p. < 0.001) of women than men with lung cancer.

[The role of sex as a prognostic factor in lung cancer]. / Znaczenie plci jako czynnika rokowniczego w raku pluca.

The aim of this study was to demonstrate the prognostic role of the gender. Lung cancer was diagnosed in 785 female and 4619 male registered in Pulmonary Outpatients Departments in 1995. Women were younger than man when all histologic types of lung cancer were analysed (59.7 vs 61.9 years of age p. < 0.001), particularly those with adenocarcinoma(56.9 vs 60.2 years of age, p. < 0.012) and small cell lung cancer (57.4 vs 59.6 years of age, p. < 0.001). Although squamous lung cancer was the most prevalent among men (43.7%) and women (24.7%), about two times higher percentage of men had this neoplasm. Adenocarcinoma (18% vs 6.6%, p. < 0.001) and small cell lung cancer (28.5% vs 15.5% p. < 0.001) were prevalent in significantly higher percentage among female than male. Women were treated more aggressively by surgery (17.1% vs 14.1%, p. = 0.04) but similar percentage of men and women received radiotherapy, chemotherapy and multimodality treatment. Women more frequently survived one year (43% vs 35.7%, p. < 0.04). Significant and independent negative prognostic factors were: gender (RR-1.17 for men), age older than 50 age (RR-1.2), bed performance status (RR-3.28), disseminated disease (RR-2.78) small cell histological type of cancer (RR-1.21) and nonsurgical therapy (RR-3.29).