Early diagnosis of surgically curable lung cancer is commonly serendipitous.

AIMS: Lung cancer is the largest cause of cancer death in New Zealand, accounting for 18.3% of cancer-related deaths.[[1,2]] There is limited literature on how patients with lung cancer clinically present in New Zealand. The aim of this cohort study was to identify the rate of incidentally diagnosed lung cancer in the Midland Region, the common symptomatology and route of diagnosis. METHODS: This retrospective cohort study included patients with lung cancer who underwent potentially curative thoracic surgery between January 2011 to June 2018 at Waikato Hospital, New Zealand. Symptoms or signs recorded were cough, dyspnoea, haemoptysis, lymphadenopathy, chest pain, hoarseness, fatigue, weight loss and finger clubbing. The lung cancer cases were grouped into incidental finding, symptomatic general practitioner, symptomatic emergency department and surveillance. RESULTS: Three hundred and ten patients with lung cancer had thoracic surgery with curative intent at Waikato Hospital. Two hundred and fourteen (69%) patients had symptoms which prompted presentation to a treating physician and 96 (31%) patients were asymptomatic. Incidental diagnosis was demonstrated in 121 (39.4%) patients. Of the patients diagnosed incidentally, 36.4% (n=44) had symptoms of lung cancer with the main symptoms including 45% with cough (n=20), 28% with dyspnoea (n=12) and 28% chest pain (n=12). CONCLUSIONS: In New Zealand, a large amount of lung cancer is still diagnosed incidentally with symptoms of cough, dyspnoea and chest pain. Further research into the development of a lung cancer screening program in New Zealand for a high-risk population is warranted.

Management of patients with early stage lung cancer - why do some patients not receive treatment with curative intent?

BACKGROUNDS: This study aims to understand the factors that influence whether patients receive potentially curative treatment for early stage lung cancer. A key question was whether indigenous Maori patients were less likely to receive treatment. METHODS: Patients included those diagnosed with early stage lung cancer in 2011-2018 and resident in the New Zealand Midland Cancer Network region. Logistic regression model was used to estimate the odds ratios of having curative surgery/ treatment. The Kaplan Meier method was used to examine the all-cause survival and Cox proportional hazard model was used to estimate the hazard ratio of death. RESULTS: In total 419/583 (71.9%) of patients with Stage I and II disease were treated with curative intent - 272 (46.7%) patients had curative surgery. Patients not receiving potentially curative treatment were older, were less likely to have non-small cell lung cancer (NSCLC), had poorer lung function and were more likely to have an ECOG performance status of 2+. Current smokers were less likely to be treated with surgery and more likely to receive treatment with radiotherapy and chemotherapy. Those who were treated with surgery had a 2-year survival of 87.8% (95% CI: 83.8-91.8%) and 5-year survival of 69.6% (95% CI: 63.2-76.0%). Stereotactic ablative body radiotherapy (SABR) has equivalent effect on survival compared to curative surgery (hazard ratio: 0.77, 95% CI: 0.37-1.61). After adjustment we could find no difference in treatment and survival between Maori and non-Maori. CONCLUSIONS: The majority of patients with stage I and II lung cancer are managed with potentially curative treatment - mainly surgery and increasingly with SABR. The outcomes of those being diagnosed with stage I and II disease and receiving treatment is positive with 70% surviving 5 years.

Characteristics of lung cancers and accuracy and completeness of registration in the New Zealand Cancer Registry.

AIMS: This study aims to report the characteristics of newly diagnosed lung cancer cases, and to examine the data accuracy of registrations in the New Zealand Cancer Registry (NZCR) in 2011-2015. METHODS: The accuracy and completeness of lung cancer registrations in the NZCR was explored using the Midland Lung Cancer Register (MLCR, including Lakes, Waikato, Tairawhiti and Bay of Plenty District Health Boards) and clinical records. A combined Midland Lung Cancer Dataset was created based on the NZCR and the MLCR. The characteristics of lung cancer cases was described and compared between Maori and non-Maori patients. The subgroup differences were examined by Chi-Square tests. The odds ratio of having small cell lung cancer compared to non-small cell lung cancer between Maori patients and non-Maori patients was estimated using the logistic regression model. RESULTS: The combined Midland Lung Cancer Dataset included 2,057 verified lung cancer registrations, including 656 (31.9%) Maori patients and 1,401 (68.1%) non-Maori patients. Maori patients were more likely to be diagnosed at a younger age, more likely to be female, more likely to be a current or ex-smoker and more likely to have small cell lung cancer than non-Maori. The difference of cancer stage at diagnosis between Maori and others was not significant. After adjustment, the odds ratio of having small cell lung cancer for Maori patients compared to non-Maori patients was 1.55 (95% CI: 1.17-2.05). The adjusted odds ratio of having small cell lung cancer was 4.06 (95% CI: 1.72-9.60) for current smokers and 2.68 (95% CI: 1.14-6.30) for ex-smokers compared to patients who never smoked. CONCLUSIONS: Combining the two sources of data gives a more complete picture of the incidence and tumour characteristics of lung cancer in our region. Our dataset suggests that Maori patients are more likely to have small cell lung cancer than non-Maori patients.

Diagnosis, treatment and prevention of gonorrhoea.

Neisseria gonorrhoeae is a Gram-negative bacteria responsible for the sexually transmitted infection gonorrhoea, which is increasingly common in the UK. Drug-resistant strains of the bacteria have emerged, which is making gonorrhoea difficult to treat. Therefore, preventing infection is important. This article identifies people at increased risk of contracting the infection, and explores how nurses can offer testing and treatment as well as helping to prevent infection through education and health promotion.