Diagnostic procedure, therapeutic care and degree of follow-up delivered to 1692 lung cancer patients over 2 years (1978–79) in 31 Italian hospitals were reviewed. The data show marked deficiencies in the various indicators analysed: staging by standard methods was recorded only in 13% of patients; reliable histocytologic classification in 54% of patients. A group of commonly accepted protocols was adopted as first-line therapy only in 49% of treated cases; 19% of patients were regularly followed according to standard programs, whereas 49% had been dropped without any information in the charts. Better performance, although not satisfactory, was found in hospitals with oncologic facilities and wards compared to centers without « ad hoc » organizations. The discussion focussed on the limits of organizational measures and efforts to determine widespread improvement in care for a disease such as lung cancer for which real therapeutic gains are still hard to achieve.
Get full access to this article
View all access options for this article.
References
1.
AisnerJ., HansenH.H.: Commentary: Current status of chemotherapy for non-small cell lung cancer.Cancer Treat. Rep., 65: 979–986, 1981.
2.
BeggC.B., CarboneP.P., ElsonP.J., ZelenM.: Participation of community hospitals in clinical trials.Analysis of five years of experience in the Eastern Cooperative Oncology Group. N. Engl. J. Med., 306: 1076–1080, 1982.
3.
BeggC.B., CohenJ.L., EllertonJ.: Are the elderly predisposed to toxicity from cancer chemotherapy?An investigation using data from the Eastern Cooperative Oncology Group. Cancer Clin. Trials, 3: 369–374, 1980.
4.
BricknerT.J. (Ed.): Carcinoma of the Breast.Radiation Oncology Study Center, Philadelphia. Patterns of Care Study Newsletter, July, 1978.
5.
CarlensE., DahlströmG., NöuE.: Comparative measurements of quality of survival of lung cancer patients after diagnosis.Scand. J. Resp. Dis., 51: 268–275, 1970.
6.
CarterS.K.: Clinical trials in patients with cancer.N. Engl. J. Med., 306: 1105–1106, 1982.
7.
CechnerR.L., ChamberlainW., CarterJ.R., Milojkovic-MircetaL., NashN.P.: Misdiagnosis of bronchogenic carcinoma.The role of cigarette smoking, surveillance bias, and other factors. Cancer, 46: 190–199, 1980.
8.
CooperJ.S., NewallJ., KramerS., PowersW.E., DavisL.W., HerringD.F., SedranskJ.: Measuring the quality of medical care: A beginning.Cancer Clin. Trials, 2: 55–58, 1979.
9.
DollR., PetoR.: The causes of cancer: Quantitative estimates of avoidable risks of cancer in the United States today.J. Natl. Cancer Inst., 66: 1191–1308, 1981.
10.
Editorial: Chemotherapy for lung cancer.Br. Med. J., 1: 815–816, 1979.
11.
Editorial: Small-cell carcinoma of the bronchus: Real progress is hard to come by.Lancet, 1: 77–78, 1980.
FeldR.: Complications in the treatment of small cell carcinoma of the lung.Cancer Treat. Rev., 8: 5–25, 1981.
14.
FreidenbergsI., GordonW., Ruckdeschel HibbardM., DillerL.: Assessment and treatment of psychosocial problems of the cancer patient: A case study.Cancer Nursing, April: 111–119, 1980.
15.
GrecoF.A., OldhamR.K.: Current concepts in cancer.Small-cell lung cancer. N. Engl. J. Med., 301: 355–358, 1979.
16.
HanksG.E., KramerS., DiamondJ.J., HerringD.F.: Patterns of care outcome survey: National outcome data for six disease sites.Am. J. Clin. Oncol., 5: 349–353, 1982.
KramerS.: The study of the patterns of cancer care in radiation therapy.Cancer, 39(suppl.): 780–787, 1977.
19.
KramerS., HerringD.F.: The patterns of care study: A nationwide evaluation of the practice of radiation therapy in cancer management.Int. J. Radiat. Oncol. Biol. Phys., 1: 1231–1236, 1976.
LiberatiA., AndreaniA., ColomboF., ConfalonieriC., FranceschiS., La VecchiaC., TognoniG.: Quality of breast cancer care in Italian general hospitals.Lancet, 2: 258–260, 1982.
22.
LiberatiA., AndreaniA., ColomboF., ConfalonieriC., TognoniG.: Care of cancer patients in thirty-one Italian general hospitals.Methodological aspects and general findings. Eur. J. Cancer Clin. Oncol., 19: 179–185, 1983.
23.
LivingstonR.B.: Combination chemotherapy or bronchogenic carcinoma.I. Non-oat cell. Cancer Treat. Rev., 4: 153–165, 1977.
24.
MacLeanC.J., DavisL.W., HerringD.F., PowersW.E., KramerS.: Variation in work-up and treatment procedures among types of radiation therapy facilities.Cancer, 48: 1346–1352, 1981.
25.
McAuliffeW.E.: Measuring the quality of medical care: Process versus outcome.Milbank Mem. Fun. Q/Health and Society, 57: 118–152, 1979.
26.
McNeilB.J., WeichselbaumR., PaukerS.G.: Fallacy of the five-year survival in lung cancer.N. Engl. J. Med., 299: 1397–1401, 1978.
27.
McNeilB.J., WeichselbaumR., PaukerS.G.: Speech and survival.Tradeoffs between quality and quantity of life in laryngeal cancer. N. Engl. J. Med., 305: 982–987, 1981.
28.
NouE., ÅbergT.: The need for surgery in an unselected bronchial carcinoma population.Thorac. Cardiovasc. Surg., 27: 347–358, 1979.
29.
PastorinoU., ValenteM., BerrinoF., CrosignaniP., RavasiG.: Modalità di trattamento per carcinoma polmonare in una popolazione non selezionata.Tumori, 67: 563–569, 1981.
30.
PerezC.A.: Radiation therapy in the management of carcinoma of the lung.Cancer, 39: 901–916, 1977.
31.
RichardsF.I., WhiteD.R., MussH.B., JacksonD.U., StuartJ.J., CooperM.R., RhyneR., SpurrC.L.: Combination chemotherapy of advanced non-oat cell carcinoma of the lung.Cancer, 44: 1576–1581, 1979.
32.
SugarbakerP.H., BarofskyI., RosenbergS.A., GianolaF.J.: Quality of life assessment of patients in extremity sarcoma clinical trials.Surgery, 91: 17–23, 1982.
33.
TobiasJ.S., HarperP.G.: Who should treat cancer?Lancet, 1: 884–886, 1981.
34.
WeissR.B., MinnaJ.D., GlatsteinE., MartiniN., HideD.C., MuggiaF.M.: Treatment of small cell undifferentiated carcinoma of the lung: Update of recent results.Cancer Treat. Rep., 64: 539–548, 1980.
