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Efforts to reduce delays in lung cancer management should not cease even though they may not affect the prognosis
It is universally acknowledged that the prognosis of lung cancer is very poor, with overall 5 year survival figures of about 5–10% worldwide.1 What is less well recognised is that the picture has changed very little over the last 20 years, and that this is in sharp distinction to other solid tumours where not only are survival rates better—in the order of 60–90%—but they have been increasing (improving) fairly rapidly and continue to do so over a comparable time. For example, in our region of the UK, comprehensive population based registry data for 2 year survival of the 5000 patients diagnosed with lung cancer in 1999 was 13% compared with 60%, 79%, 87% and 92% for colorectal, cervix, prostate, and breast cancer, respectively.2 There is merit therefore in considering what might influence and be responsible for this poor outcome.
FACTORS AFFECTING PROGNOSIS IN LUNG CANCER
The factors which affect the prognosis in lung cancer are principally the stage and related performance status at presentation, histology (that is, the biological activity of the tumour), co-morbidity, age, sex, and the time interval between first symptom and treatment.
Some of these factors are not modifiable. In theory, however, reducing intervals between presentation and treatment might downstage patients and allow an improvement in survival. There are excellent data to show that early stage disease has better survival;3 there is less good but nevertheless fairly convincing evidence that very early stage disease (that is, small asymptomatic lesions) have an even better prognosis.
There are, of course, other ways of reducing lung cancer mortality. In the very long term, over a period of decades, prevention is clearly key. In the longer term, over a 5–10 year time span, the identification …