172 Best practice in small cell lung cancer: Are we meeting national guidance? A 3 year audit of treatment and outcomes in Bournemouth, Dorset, UK

Abstract

Introduction: Small Cell Lung Cancer is an aggressive malignancy with a poor prognosis. Treatment delays and non-adherence to evidence based practice guidelines can lead to poorer outcome. Method: All patients with a confirmed pathological diagnosis of small cell carcinoma between 1st January 2007 and 31st December 2009 were eligible. Data from our electronic patient record system, chemotherapy prescribing system, lung cancer data base and the clinical notes was evaluated. Data was compared to NICE guidelines and the NHS National Lung Cancer Audit recommendations. Results: Forty one patients were identified. Completeness for key data fields was 100%. Median age at diagnosis was 70 years (range 50 91 years); 27 males and 14 females. Forty (98%) were discussed at MDT. Limited-stage (LD) was diagnosed in 11 (27%) and extensive-stage (ED) in 30 (73%). Nine (82%) patients with LD received chemotherapy (including 6 who received radical concurrent or sequential chemoradiotherapy). 22 (73%) patients with ED received chemotherapy (including 5 who received palliative sequential thoracic radiotherapy). Median time from diagnosis to chemotherapy was 12 days (range 3 29). 26 patients (84%) receiving chemotherapy had radiological evidence of disease response. In line with evidence available at the time, prophylactic cranial irradiation (PCI) was considered for eligible patients, although only 8 patients (47%) went on to complete treatment. Median survival for all patients was 9 months (range 0 46 months), rising to 11 months for those receiving at least one cycle of chemotherapy. Conclusions: Overall clinical outcome for this unselected population is in keeping with published literature. Chemotherapy rates exceed the recommended 62% suggesting prompt diagnosis and timely referral to commence treatment where appropriate. PCI rates were lower than might be expected. Data capture for patients with SCLC at RBH is excellent with key demographic and clinical parameters recorded.