Five years managing metastatic non-small cell lung cancer: experience at a teaching hospital

Background: The management of patients with metastatic non-small cell lung cancer (NSCLC) is complex. Some studies have demonstrated that the care of patients with NSCLC may be suboptimal. Aim: To review the management of patients with metastatic NSCLC treated at a single teaching hospital over a 5-year period. Method: All patients with metastatic NSCLC treated at a single teaching hospital over a 5-year period (1998-2002) were identified. Data were collected by a retrospective record review. Results: Of 343 patients with metastatic NSCLC, 157 patients were deemed eligible for this review. Thirty-one patients (19%) were admitted to the Medical Oncology Unit at initial presentation. Twenty-four patients (15%) were not referred to either the Medical Oncology Unit or the Palliative Care Unit. Forty-four patients (28%) received chemotherapy, six of whom (14%) were enrolled onto a clinical trial. Six separate chemotherapy regimens were used. The median survival was 5 months and the 1-year survival rate was 19.8%. Conclusions: The present audit demonstrates some shortfalls in the optimal clinical care of patients with metastatic NSCLC at a large teaching hospital. The main selection criteria of consideration for chemotherapy are age, performance status and presence of symptoms. A subset of patients was not referred to either the Medical Oncology Unit or the Palliative Care Unit and consistency in the choice of chemotherapy was lacking. Survival data and the rate of patients entered onto clinical trials are acceptable; however, further improvements can be made by the institution of multidisciplinary clinics and the education of referring clinicians.