Abstract
BackgroundDespite the progress seen in the last decade in diagnosis and treatment, lung cancer has still a bad prognosis and a substantial number of patients died within the weeks following diagnosis. The objective of this study was to quantify early mortality in lung cancer, to identify patients who are at high risk of early decease, and to describe their management in a real world.MethodsProspective observational study including consecutively all adult patients managed for primary lung cancer histologically or cytologically diagnosed in 2010 in the respiratory medicine department of one of the participating French general hospitals. Patients and cancer characteristics and first therapeutic strategy were collected at diagnosis. Dates of death were obtained from investigators or town council of the patient’s birth place. All fatal cases were considered regardless of the cause of the death. Multivariate logistic regression model was used to determine the factors significantly and independently associated with death at 1 and 3 months.ResultsSeven thousand fifty-one patients from 104 centres were included in the study. Vital status was obtained for 6,981 patients. Respectively, 678 (9.7 %) and 1,621 (23.2 %) of the 6,981 patients with available data died within 1 and 3 months following diagnosis. As compared with the other patients, they were significantly older and frailer (based on performance status [PS] and recent weight loss) and more frequently reported stage IV tumour. Overall, 64.5 % (1 month) and 42.8 % (3 months) of patients had no cancer therapy and less than 1 % were included in a therapeutic trial.ConclusionAbout one in four patients died within 3 months following lung cancer diagnosis. Early mortality mainly involves frail patients with advanced cancer and is associated with lack of cancer therapy. This supports the need for early diagnosis and clinical trials in this population. Reducing early mortality to give supplementary time to patients to organise the future is a major challenge for 21st century physicians.
Highlights
Despite the progress seen in the last decade in diagnosis and treatment, lung cancer has still a bad prognosis and a substantial number of patients died within the weeks following diagnosis
At the end of 2009, the members of the Collège des Pneumologues des Hôpitaux Généraux (CPHG) which gathers the chest physicians of the respiratory departments of the French general hospitals were contacted
Some patients were excluded from the study as they presented with major protocol failures: i.e., no information on histological or cytological sampling, sampling date outside of the recommended window, primary lung cancer not confirmed at histology, or cancer managed outside of the study centre
Summary
Despite the progress seen in the last decade in diagnosis and treatment, lung cancer has still a bad prognosis and a substantial number of patients died within the weeks following diagnosis. The objective of this study was to quantify early mortality in lung cancer, to identify patients who are at high risk of early decease, and to describe their management in a real world. Despite the progress seen in the last decade in diagnosis and treatment, lung cancer has still a bad prognosis [1]. In France, in 2010, 1-year mortality rate in patients with lung cancer was estimated at 56 % [2]
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