RESUMEN
Lung cancer screening has come a long way since the early studies with chest X-ray. Advancing technology and progress in the processing of images have enabled low dose CT to be tried and tested, and evidence suggests its use can result in a significant mortality benefit. There are several issues that need refining in order to successfully implement screening in the UK and elsewhere. Some countries have started patchy implementation of screening and there is increased recognition that the appropriate management of pulmonary nodules is crucial to optimise benefits of early detection, while reducing harm caused by inappropriate medical intervention. This review summarises and differentiates the many recent guidelines on pulmonary nodule management, discusses screening activity in other countries and exposes the present barriers to implementation in the UK.
Asunto(s)
Neoplasias Pulmonares/diagnóstico por imagen , Nódulos Pulmonares Múltiples/diagnóstico por imagen , Nódulo Pulmonar Solitario/diagnóstico por imagen , Tomografía Computarizada por Rayos X/tendencias , Detección Precoz del Cáncer/tendencias , Guías como Asunto , Humanos , Valor Predictivo de las Pruebas , Sensibilidad y EspecificidadRESUMEN
BACKGROUND: Lung cancer screening using low-dose CT (LDCT) was shown to reduce lung cancer mortality by 20% in the National Lung Screening Trial. METHODS: The pilot UK Lung Cancer Screening (UKLS) is a randomised controlled trial of LDCT screening for lung cancer versus usual care. A population-based questionnaire was used to identify high-risk individuals. CT screen-detected nodules were managed by a pre-specified protocol. Cost effectiveness was modelled with reference to the National Lung Cancer Screening Trial mortality reduction. RESULTS: 247â 354 individuals aged 50-75â years were approached; 30.7% expressed an interest, 8729 (11.5%) were eligible and 4055 were randomised, 2028 into the CT arm (1994 underwent a CT). Forty-two participants (2.1%) had confirmed lung cancer, 34 (1.7%) at baseline and 8 (0.4%) at the 12-month scan. 28/42 (66.7%) had stage I disease, 36/42 (85.7%) had stage I or II disease. 35/42 (83.3%) had surgical resection. 536 subjects had nodules greater than 50â mm(3) or 5â mm diameter and 41/536 were found to have lung cancer. One further cancer was detected by follow-up of nodules between 15 and 50â mm(3) at 12â months. The baseline estimate for the incremental cost-effectiveness ratio of once-only CT screening, under the UKLS protocol, was £8466 per quality adjusted life year gained (CI £5542 to £12â 569). CONCLUSIONS: The UKLS pilot trial demonstrated that it is possible to detect lung cancer at an early stage and deliver potentially curative treatment in over 80% of cases. Health economic analysis suggests that the intervention would be cost effective-this needs to be confirmed using data on observed lung cancer mortality reduction. TRIAL REGISTRATION: ISRCTN 78513845.
Asunto(s)
Detección Precoz del Cáncer/métodos , Neoplasias Pulmonares/diagnóstico , Tamizaje Masivo/métodos , Tomografía Computarizada por Rayos X/métodos , Anciano , Femenino , Humanos , Neoplasias Pulmonares/epidemiología , Masculino , Persona de Mediana Edad , Proyectos Piloto , Prevalencia , Pronóstico , Reproducibilidad de los Resultados , Encuestas y Cuestionarios , Reino Unido/epidemiologíaRESUMEN
BACKGROUND: Chemotherapy improves survival for many patients with SCLC, and hence it is important to understand variations in practice and outcomes for this treatment strategy. METHODS: We used the National Lung Cancer Audit and Hospital Episodes Statistics to determine the proportion of patients who received chemotherapy for SCLC, and assess the effects of patient and organisational factors on the odds of receiving chemotherapy and of completing four cycles. We calculated median survival and used Cox regression to determine factors that predicted survival. RESULTS: Of 15 091 cases of SCLC, 70% received at least one cycle of chemotherapy. More deprived people were less likely to receive chemotherapy, but patients were more likely to receive chemotherapy, and to complete ≥ four cycles, if they were referred to the lung cancer team by their GP. Median survival for those treated with chemotherapy was 12.9 months for limited and 7.3 months for extensive stage disease. CONCLUSIONS: The Linked NLCA and HES data provide real-life measures of survival in people treated with chemotherapy and show how this is influenced by patient and tumour characteristics. These data show the characteristics of patients who are less likely to complete a full course of treatment, an adverse predictor of survival.
Asunto(s)
Antineoplásicos/uso terapéutico , Neoplasias Pulmonares/tratamiento farmacológico , Cooperación del Paciente , Carcinoma Pulmonar de Células Pequeñas/tratamiento farmacológico , Anciano , Anciano de 80 o más Años , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Femenino , Humanos , Neoplasias Pulmonares/mortalidad , Masculino , Persona de Mediana Edad , Carcinoma Pulmonar de Células Pequeñas/mortalidad , Sobrevida , Resultado del TratamientoRESUMEN
BACKGROUND: In comparison with other European and North American countries, England has poor survival figures for lung cancer. Our aim was to evaluate the changes in survival since the introduction of the National Lung Cancer Audit (NLCA). METHODS: We used data from the NLCA to identify people with non-small-cell lung cancer (NSCLC) and stratified people according to their performance status (PS) and clinical stage. Using Cox regression, we calculated hazard ratios (HRs) for death according to the year of diagnosis from 2004/2005 to 2010; adjusted for patient features including age, sex and co-morbidity. We also assessed whether any changes in survival were explained by the changes in surgical resection rates or histological subtype. RESULTS: In this cohort of 120,745 patients, the overall median survival did not change; but there was a 1% annual improvement in survival over the study period (adjusted HR 0.99, 95% confidence interval (CI) 0.98-0.99). Survival improvement was only seen in patients with good PS and early stage (adjusted HR 0.97, 95% CI 0.95-0.99) and this was partly accounted for by changes in resection rates. CONCLUSION: Survival has only improved for a limited group of people with NSCLC and increasing surgical resection rates appeared to explain some of this improvement.
Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas/mortalidad , Neoplasias Pulmonares/mortalidad , Anciano , Carcinoma de Pulmón de Células no Pequeñas/patología , Carcinoma de Pulmón de Células no Pequeñas/cirugía , Estudios de Cohortes , Inglaterra/epidemiología , Femenino , Humanos , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/cirugía , Masculino , Auditoría Médica , Persona de Mediana Edad , Mortalidad/tendencias , Estadificación de Neoplasias , Modelos de Riesgos Proporcionales , Procedimientos Quirúrgicos Pulmonares/estadística & datos numéricos , Análisis de Regresión , Tasa de SupervivenciaRESUMEN
BACKGROUND: Our aim was to systematically determine how features of patients and hospitals influence access to chemotherapy and survival for people with small-cell lung cancer in England. METHODS: We linked the National Lung Cancer Audit and Hospital Episode Statistics and used multiple logistic and Cox regression analyses to assess the influence of patient and hospital features on small-cell lung cancer outcomes. RESULTS: There were 7845 patients with histologically proven small-cell lung cancer. Sixty-one percent (4820) of the patients received chemotherapy. Increasing age, worsening performance status, extensive stage and greater comorbidity all reduced the likelihood of receiving chemotherapy. There was wide variation in access to chemotherapy between hospitals in general and patients first seen in centres with a strong interest in clinical trials had a higher odds of receiving chemotherapy (adjusted odds ratio 1.42, 95% confidence interval (CI) 1.06, 1.90). Chemotherapy was associated with a lower mortality rate (adjusted hazard ratio 0.51, 95% CI 0.46, 0.56). CONCLUSION: Patients first seen at a hospital with a keen interest in clinical trials are more likely to receive chemotherapy, and chemotherapy was associated with improved survival.
Asunto(s)
Neoplasias Pulmonares/tratamiento farmacológico , Neoplasias Pulmonares/mortalidad , Carcinoma Pulmonar de Células Pequeñas/tratamiento farmacológico , Carcinoma Pulmonar de Células Pequeñas/mortalidad , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Ensayos Clínicos como Asunto , Comorbilidad , Inglaterra , Femenino , Accesibilidad a los Servicios de Salud , Hospitales , Humanos , Masculino , Persona de Mediana Edad , Análisis de SupervivenciaRESUMEN
The UK Lung Screen (UKLS) is a randomised controlled trial of the use of low-dose multidetector CT for lung cancer screening. It completed the Health Technology Appraisal (HTA)-funded feasibility stage in October 2009 and the pilot UKLS will be initiated in early 2011. The pilot will randomise 4000 subjects to either low-dose CT screening or no screening. The full study, due to start in September 2012, if progression criteria are met, will randomise a further 28,000 subjects from seven centres in the UK. Subjects will be selected if they have sufficient risk of developing lung cancer according to the Liverpool Lung Project risk model. The UKLS employs the 'Wald Single Screen Design', which was modelled in the UKLS feasibility study. This paper describes the modelling of nodule management in UKLS by using volumetric analysis with a single initial screen design and follow-up period of 10 years. This modelling has resulted in the development and adoption of the UKLS care pathway, which will be implemented in the planned CT screening trial in the UK.
Asunto(s)
Neoplasias Pulmonares/diagnóstico por imagen , Ensayos Clínicos Controlados Aleatorios como Asunto/métodos , Anciano , Protocolos Clínicos , Vías Clínicas/organización & administración , Progresión de la Enfermedad , Detección Precoz del Cáncer/métodos , Humanos , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/terapia , Persona de Mediana Edad , Estudios Multicéntricos como Asunto/métodos , Grupo de Atención al Paciente , Selección de Paciente , Dosis de Radiación , Proyectos de Investigación , Factores de Tiempo , Tomografía Computarizada por Rayos X/métodosAsunto(s)
Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/terapia , Nódulos Pulmonares Múltiples/diagnóstico , Nódulos Pulmonares Múltiples/terapia , Nódulo Pulmonar Solitario/diagnóstico , Nódulo Pulmonar Solitario/terapia , Biopsia , Broncoscopía , Ablación por Catéter , Árboles de Decisión , Humanos , Imagen por Resonancia Magnética , Imagen Multimodal , Neumonectomía , Tomografía de Emisión de Positrones , Tomografía Computarizada de Emisión de Fotón Único , Tomografía Computarizada por Rayos X , Reino UnidoRESUMEN
PURPOSE: Appropriate lung nodule management is essential to minimizing unnecessary patient recall in lung cancer screening. Two European guidelines provide differing recommendations in that participants with nodules ≥100 mm3 or ≥80 mm3 respectively should be recalled, at baseline. Nodule size estimation is known to vary between volumetry software packages (VSPs). The aim of this study was to examine the impact of choice of VSP on participant recall rates, when applying different European nodule management guidelines. An additional aim was to compare recall rates between 7 VSPs and manual diameter measurements. METHODS: 156 small-sized lung nodules (50-150 mm3) from the UK Lung Screening trial were measured using 7 different VSPs (VSP1-7) and also using manual diameter. The type of VSP used in the NELSON study (VSP1), on which European nodule management guidelines are based, provided the reference standard. Nodule size was compared using Bland Altman, and recall rates by Mcnemar's test. RESULTS: Compared to the reference standard, a 100 mm3 threshold for recall, resulted in no difference in recall rates only for VSP 5 & 7. Using an 80mm3 threshold resulted in no difference in recall rates for VSP2 & 6. Recall rates were significantly higher for VSP 4 regardless of threshold and when using manual diameter measurements. CONCLUSIONS: Appropriate nodule size thresholds for recall in screening depend on the type of volumetry software used. The results highlight the importance of benchmarking of volumetry packages.
Asunto(s)
Detección Precoz del Cáncer/métodos , Neoplasias Pulmonares/patología , Toma de Decisiones Clínicas , Humanos , Pulmón/diagnóstico por imagen , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/prevención & control , Programas Informáticos , Nódulo Pulmonar Solitario/diagnóstico por imagen , Nódulo Pulmonar Solitario/patología , Tomografía Computarizada por Rayos X/métodos , Carga TumoralRESUMEN
Lung cancer is the most common cause of cancer death in the UK, and survival from the disease is persistently poor. Efforts to improve outcomes for patients have focused on ways of reducing late diagnosis of the disease, and access to optimal treatment. Research on lung cancer screening has so far provided some evidence of an impact on lung cancer mortality, but there is some debate about whether implementation of a national screening programme should await further trial data, principally that from the NELSON trial. The ongoing poor outcomes and the belief amongst some clinicians that there is sufficient evidence has prompted several local projects testing out lung screening in their communities, sometimes referred to as lung health checks or proactive approaches to high-risk individuals. Funding from NHS England has been forthcoming to support this. Acknowledging roll-out of such activities, which effectively constitute local lung screening in the absence of a NSC recommendation, it was timely to bring key national stakeholders together with academic and clinical experts, to agree a way forward. Cancer Research UK therefore convened a closed workshop in March 2018, involving national and international expertise. This paper outlines the proceedings, key discussion points, highlighted research gaps, and areas of consensus and next steps.
Asunto(s)
Neoplasias Pulmonares/diagnóstico , Ensayos Clínicos como Asunto , Consenso , Detección Precoz del Cáncer/métodos , Humanos , Tamizaje Masivo/métodos , Reino UnidoRESUMEN
UNLABELLED: There are few data published on lung cancer survival in the UK. Survival rates for lung cancer at a UK Hospital between 1998-2001 are described. METHODS: Analysis of data collected from multidisciplinary team (MDT) meetings, lung cancer registrations and hospital coding. RESULTS: 835 new lung cancers were diagnosed comprising 597 non-small cell lung cancers (NSCLC) (71%), 133 small cell (SCLC) (16%), and 105 clinical diagnoses (13%). Stage at diagnosis; stage I (25%), II (9%), IIIA (8%), IIIB (23%), IV (35%). Surgery was undertaken in 12%, radical radiotherapy (RT) in 4%, palliative RT in 32%, chemotherapy in 8% and best supportive care (BSC) in 36%. The 3-year cumulative survival for NSCLC was: stage I 39%, stage II 30%, stage III 6%, stage IV 0.5%. Only 46% of patients with stage I-IIIA disease received radical treatment. Reasons included poor lung function (32%), unresectable (24%), co-morbidities (17%), performance status (8%), patient choice (8%), unclear (6%), advanced age (5%). CONCLUSIONS: Survival figures are similar to other UK studies but do not compare favourably with US and European data. This may be because a large proportion of patients with early stage disease receive palliative care only.
Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas/patología , Carcinoma de Pulmón de Células no Pequeñas/terapia , Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/terapia , Quimioterapia Adyuvante , Terapia Combinada , Hospitales de Enseñanza , Hospitales Urbanos , Humanos , Neoplasias Pulmonares/diagnóstico , Estadificación de Neoplasias , Cuidados Paliativos , Radioterapia Adyuvante , Sistema de Registros , Estudios Retrospectivos , Análisis de Supervivencia , Resultado del Tratamiento , Reino UnidoRESUMEN
Early diagnosis of lung cancer is currently the most effective way of reducing lung cancer mortality other than quitting smoking because the treatment of late stage disease has little impact. Improving the awareness of the risk of lung cancer and warning symptoms, recognition and prompt referral, and screening with low dose computed tomography (LDCT) are potential ways to improve early diagnosis. Currently the evidence is strongest for LDCT, where one large trial, the US National Lung Screening Trial (NLST), showed a 20% relative reduction in lung cancer-related mortality and a 6.7% reduction in all-cause mortality in patients who had LDCT compared with chest X-ray. Although many questions remain about optimal methodology and cost-effectiveness, lung cancer screening is now being implemented in the USA using the NLST screening criteria. Many of these questions are being answered by on-going European trials that are reporting their findings. Here we review the research evidence for LDCT screening and explore the important issues that need to be addressed to optimise effectiveness.
Asunto(s)
Detección Precoz del Cáncer/normas , Neoplasias Pulmonares/diagnóstico , Tomografía Computarizada por Rayos X/métodos , Ensayos Clínicos como Asunto , Análisis Costo-Beneficio , Detección Precoz del Cáncer/economía , Detección Precoz del Cáncer/métodos , Humanos , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/prevención & controlRESUMEN
The prevailing questions at this time in both the public mind and the clinical establishment is, do we have sufficient evidence to implement lung cancer Computed Tomography (CT) screening in Europe? If not, what is outstanding? This review addresses the twelve major areas, which are critical to any decision to implement CT screening and where we need to assess whether we have sufficient evidence to proceed to a recommendation for implementation in Europe. The readiness level of these twelve categories in 2015 have been with colour coded, where green indicates we have sufficient evidence, amber is borderline evidence and red requires further evidence. Recruitment from the 'Hard to Reach' community still remains at red, while mortality data, cost effectiveness and screening interval are all categorised as amber. The integration of smoking cessation into CT screening programmes is still considered to be category amber. The US Preventive Services Task Force have recommended that CT screening is implemented in the USA utilising the NLST criteria, apart from continuing screening to 80 years of age. The cost effectiveness of the NLST was calculated to be $81,000/QALY, however, its well recognised that the costs of medical care in the USA, is far higher than that of Europe. Medicare have agreed to cover the cost of screening but have stipulated a number of stringent requirements for inclusion. To date we do not have good CT screening mortality data available in Europe and eagerly await the publication of the NELSON trial data in 2016 and then the pooled UKLS and NELSON data thereafter. However in the meantime we should start planning for implementation in Europe, especially in the areas of the radiological service provision and accreditation, as well as identifying novel mechanisms to recruit from the hardest to reach communities.
Asunto(s)
Detección Precoz del Cáncer/normas , Neoplasias Pulmonares/epidemiología , Anciano , Detección Precoz del Cáncer/métodos , Femenino , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/prevención & control , Masculino , Persona de Mediana Edad , Estados Unidos/epidemiologíaRESUMEN
INTRODUCTION: Histological diagnosis of malignant mesothelioma requires an invasive procedure such as CT-guided needle biopsy, thoracoscopy, video-assisted thorascopic surgery (VATs) or thoracotomy. These invasive procedures encourage tumour cell seeding at the intervention site and patients can develop tumour nodules within the chest wall. In an effort to prevent nodules developing, it has been widespread practice across Europe to irradiate intervention sites postprocedure--a practice known as prophylactic irradiation of tracts (PIT). To date there has not been a suitably powered randomised trial to determine whether PIT is effective at reducing the risk of chest wall nodule development. METHODS AND ANALYSIS: In this multicentre phase III randomised controlled superiority trial, 374 patients who can receive radiotherapy within 42 days of a chest wall intervention will be randomised to receive PIT or no PIT. Patients will be randomised on a 1:1 basis. Radiotherapy in the PIT arm will be 21 Gy in three fractions. Subsequent chemotherapy is given at the clinicians' discretion. A reduction in the incidence of chest wall nodules from 15% to 5% in favour of radiotherapy 6 months after randomisation would be clinically significant. All patients will be followed up for up to 2 years with monthly telephone contact and at least four outpatient visits in the first year. ETHICS AND DISSEMINATION: PIT was approved by NRES Committee North West-Greater Manchester West (REC reference 12/NW/0249) and recruitment is currently on-going, the last patient is expected to be randomised by the end of 2015. The analysis of the primary end point, incidence of chest wall nodules 6 months after randomisation, is expected to be published in 2016 in a peer reviewed journal and results will also be presented at scientific meetings and summary results published online. A follow-up analysis is expected to be published in 2018. TRIAL REGISTRATION NUMBER: ISRCTN04240319; NCT01604005; Pre-results.
Asunto(s)
Neoplasias Pulmonares/prevención & control , Mesotelioma/prevención & control , Siembra Neoplásica , Neoplasias Pleurales/prevención & control , Complicaciones Posoperatorias/prevención & control , Adulto , Anciano , Atención Ambulatoria , Antineoplásicos/uso terapéutico , Quimioterapia Adyuvante , Protocolos Clínicos , Femenino , Humanos , Neoplasias Pulmonares/radioterapia , Neoplasias Pulmonares/cirugía , Masculino , Mesotelioma/radioterapia , Mesotelioma/cirugía , Mesotelioma Maligno , Selección de Paciente , Neoplasias Pleurales/radioterapia , Neoplasias Pleurales/cirugía , Cuidados Posoperatorios/métodos , Radioterapia Adyuvante , Neoplasias Torácicas/prevención & control , Neoplasias Torácicas/secundario , Pared Torácica , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: Stage I non-small cell lung cancer (NSCLC) is potentially curable, and surgery is considered to be the standard of care for patients with good performance status and minimal co-morbidity. However, a significant proportion of patients with stage I NSCLC have a poorer performance status and significant medical co-morbidity that make them at higher risk of morbidity and mortality from surgery. Stereotactic ablative radiotherapy (SABR), which uses modern radiotherapeutic techniques to deliver large doses of radiation, has shown superiority over conventional radiotherapy in terms of local control and toxicity and is a standard of care for patients with stage I NSCLC who are at too high risk for surgery. However, it is not known whether surgery or SABR is the most effective in patients with stage I NSCLC who are suitable for surgery but are less fit and at higher risk surgical complications. Previous randomised studies have failed to recruit in this setting, and therefore, a feasibility study is required to see whether a full randomised control trial would be possible. METHODS/DESIGN: SABRTooth is a UK-based, multi-centre, open-label, two-group individually (1:1) randomised controlled feasibility study in patients with peripheral stage I NSCLC considered to be at higher risk from surgical resection. The study will assess the feasibility of conducting a definitive large-scale phase III trial. The primary objective is to assess recruitment rates to provide evidence that, when scaled up, recruitment to a large phase III trial would be possible; the target recruitment being 54 patients in total, over a 21-month period. There are multiple secondary and exploratory objectives designed to explore the optimum recruitment and data collection strategies to help optimise the design of a future phase III trial. DISCUSSION: To know whether SABR is a better, equivalent or inferior alternative to surgery for higher risk patients is a key question in lung cancer. Other studies comparing SABR to surgery have closed early due to poor recruitment, and therefore, the SABRTooth feasibility study has been designed around the UK National Health Service (NHS) cancer pathway incorporating many design features in order to maximise recruitment for a future definitive phase III trial. TRIAL REGISTRATION: controlled-trials.com ISRCTN13029788.
RESUMEN
[This corrects the article DOI: 10.1186/s40814-016-0046-2.].
RESUMEN
Deaths from lung cancer are greater than for any other type of malignancy. Many people present with advanced stage cancer at diagnosis and survival is limited. Low radiation dose CT (LDCT) screening appears to offer part of the solution to this. The US National Lung Screening Trial (NLST) showed a 20% reduction in cancer related mortality and a 6.7% reduction in all cause mortality in patients who had LDCT compared to chest X-ray. Lung Cancer screening is now being implemented in the US using the NLST screening criteria but many questions remain about the details of the methodology of screening and its cost effectiveness. Many of these questions are being answered by ongoing European trials that are reporting their findings. In this review we objectively analyse current research evidence and explore the issues that need to be resolved before implementation, including technical considerations, selection criteria and effective nodule management protocols. We discuss the potential barriers that will be faced when beginning a national screening programme and possible solutions to them.
Asunto(s)
Detección Precoz del Cáncer/métodos , Neoplasias Pulmonares/diagnóstico , Radiografías Pulmonares Masivas , Tamizaje Masivo/métodos , Tomografía de Emisión de Positrones , Tomografía Computarizada por Rayos X , Análisis Costo-Beneficio , Medicina Basada en la Evidencia , Salud Global , Humanos , Neoplasias Pulmonares/economía , Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/terapia , Radiografías Pulmonares Masivas/métodos , Estadificación de Neoplasias , Selección de Paciente , Guías de Práctica Clínica como Asunto , Valor Predictivo de las Pruebas , Ensayos Clínicos Controlados Aleatorios como Asunto , Medición de Riesgo , Factores de Riesgo , Sensibilidad y EspecificidadAsunto(s)
Detección Precoz del Cáncer/métodos , Neoplasias Pulmonares/diagnóstico por imagen , Nódulos Pulmonares Múltiples/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Diagnóstico Diferencial , Humanos , Hallazgos Incidentales , Neoplasias Pulmonares/complicaciones , Ilustración Médica , Nódulos Pulmonares Múltiples/etiologíaRESUMEN
BACKGROUND: Non-small cell lung cancer (NSCLC) in young adults is a rare but devastating illness with significant socioeconomic implications, and studies of this patient subgroup are limited. AIM: This study employed the National Lung Cancer Audit to compare the clinical features and survival of young adults with NSCLC with the older age groups. DESIGN: A retrospective cohort review using a validated national audit dataset. METHODS: Data were analysed for the period between 1 January 2004 and 31 December 2011. Young adults were defined as between 18 and 39 years, and all others were divided into decade age groups, up to the 80 years and above group. We performed logistic and Cox regression analyses to assess clinical outcomes. RESULTS: Of a total of 1 46 422 patients, 651 (0.5%) were young adults, of whom a higher proportion had adenocarcinoma (48%) than in any other age group. Stage distribution of NSCLC was similar across the age groups and 71% of young patients had stage IIIb/IV. Performance status (PS) was 0-1 for 85%. Young adults were more likely to have surgery and chemotherapy compared with the older age groups and had better overall and post-operative survival. The proportion with adenocarcinoma, better PS and that receiving surgery or chemotherapy diminished progressively with advancing decade age groups. CONCLUSION: In our cohort of young adults with NSCLC, the majority had good PS despite the same late-stage disease as older patients. They were more likely to have treatment and survive longer than older patients.
Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas/patología , Neoplasias Pulmonares/patología , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Tumor Carcinoide/mortalidad , Tumor Carcinoide/patología , Carcinoma de Pulmón de Células no Pequeñas/mortalidad , Carcinoma de Pulmón de Células no Pequeñas/terapia , Inglaterra/epidemiología , Humanos , Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/terapia , Persona de Mediana Edad , Estudios Retrospectivos , Distribución por Sexo , Factores Socioeconómicos , Análisis de Supervivencia , Adulto JovenRESUMEN
OBJECTIVES: Lung cancer surgery leads to long term survival for some patients but little is known about how patients decide whether to accept the associated surgical risks. The objective of this qualitative study was to explore patients' attitudes to the risks associated with lung cancer surgery. METHODS: Fifteen patients with resectable lung cancer, recruited via multi-disciplinary team meetings at an English tertiary referral centre, participated in semi-structured interviews to explore their attitudes to the morbidity and mortality risks associated with lung cancer surgery. Transcripts were analysed using the framework method. RESULTS: Participants reported being 'pleased' to hear that they were suitable for surgery and felt that surgery was not a treatment to be turned down because they did not see any alternatives. Participants had some knowledge of perioperative risks, including mortality estimates; however, many voiced a preference not to know these risks and to let the medical team decide their treatment plan. Some found it difficult to relate the potential risks and complications of surgery to their own situation and appeared willing to accept high perioperative mortality risks. Generally, participants were willing to accept quite severe long-term postoperative breathlessness; however, it was apparent that many actually found this possibility difficult to imagine. CONCLUSION: Patients do not necessarily wish to know details of risks associated with lung cancer surgery and may wish to defer decisions about treatment to their medical team. Investment in the doctor-patient relationship, particularly for the surgeon, is therefore important in the management of patients with lung cancer.
Asunto(s)
Neoplasias Pulmonares/psicología , Neoplasias Pulmonares/cirugía , Aceptación de la Atención de Salud/psicología , Procedimientos Quirúrgicos Pulmonares/psicología , Anciano , Anciano de 80 o más Años , Actitud , Femenino , Humanos , Masculino , Persona de Mediana Edad , Relaciones Médico-Paciente , RiesgoRESUMEN
STUDY OBJECTIVES: We reviewed our short- (30 days) and long-term (up to 17 years) experience with surgical revascularization for patients with angiographically documented isolated single-vessel coronary artery disease. DESIGN: Retrospective study of single-vessel coronary artery bypass procedures performed from January 1980 through June 1996. During this time, 100 consecutive patients underwent a single-vessel coronary artery bypass. All patients were men with a mean age of 59+/-9 years (range, 35 to 78 years) and a mean ejection fraction of 56+/-8% (range, 35 to 77%). The vessels bypassed included the left anterior descending in 66 (66%), right coronary artery in 31 (31%), and the obtuse marginal in 3 (3%). RESULTS: Short-term results reveal no deaths and six (6.0%) complications. Long-term follow-up by chart review and telephone survey was available in 87 (87%) patients at a mean of 46.9 months (range, 12 to 151 months). Cumulative freedom from angina and repeated revascularization was 93% and 98% at 1 year and 55% and 81% at 10 years, respectively (Kaplan-Meier). CONCLUSION: Single-vessel coronary artery bypass for isolated single-vessel disease can be performed with minimal morbidity and no mortality and provides excellent long-term relief of angina.