Introduction and Objectives Lung Cancer patients with a PS3 often fall on the boundary between fitness for active oncological treatments and “best supportive care”. Some patients with PS3 are deteriorating rapidly because of advanced cancer symptoms and have a very poor prognosis. Others have stable chronic health problems that influence PS.
- To determine the percentage of patients with PS3 who fall into these subcategories and compare 12 month survival
- To ask whether having a tissue diagnosis in patients with PS3 improves outcome.
Assigning a PS3 to a patient may influence whether or not a tissue diagnosis is pursued. In some cases this may be because the patient has severe cardiorespiratory disease and a biopsy is unsafe. In other cases, the multidisciplinary team may decide that the patient is not fit to have active oncological treatment so pursuing a biopsy would not alter management, and might even be unethical because of the risk incurred.
Methods All lung cancer units in MCCN were asked to complete a questionnaire for 50 consecutive Lung Cancer patients with PS3 (most were diagnosed in 2010), which was then compared with death data from the North West Cancer Intelligence Service.
Results Survival is generally greater in patients who are given a PS3 because they are stable due to chronic illness (34.5% were alive after 12 months) and poorer in those deteriorating due to advanced cancer symptoms (4.1%) or a combination of the two (13.1%).
In neither patients with PS3 because of ill health, nor patients with PS3 because of advanced cancer symptoms was there a clear survival advantage for patients who had a tissue diagnosis of cancer as opposed to a clinical and radiological diagnosis.
Conclusions Based on this data, there is no explicit survival advantage in pursuing tissue diagnosis in patients with PS3. In our network, those patients with PS3 who are fit for active oncological treatment received it even when it was considered inappropriate to pursue histology. In the future, should targeted therapies become available that can be tolerated in patients with PS3, the case for pursuit of histology will be stronger.