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AUDIT OF MANAGEMENT PRACTICES AND OUTCOME IN PATIENTS WITH LUNG CANCER IN SE. OF SCOTLAND. R.J. Fergusson (l), A. Gregor (2) on behalf of the South East Scotland Lung Cancer Group (SESLCG). 1. Department of Medicine, Eastern General Hospital, Edinburgh. 2. Department of Clinical Oncology, University of Edinburgh.

In order to evaluate management of practices and outcomes for an unselected population of lung cancer patients, the SESLCG undertook a prospective audit of patients presenting to its members. Between 01103/91 and 29/02/92 they registered 622 patients (419 male, mean age 68 years) from a population of 1.1 million. 60% were referred from primary care. Histology was proven in 510 (62%) with 31% squamous. 20% small cell, 13% adenocarcinoma. The mean duration of symptoms prior to referral was 70 days. 403 (65%) had inpatient assessment at presentation (mean stay 5.6 days). In 52% the diagnosis was made on the day of referral end within 2 weeks in 67%. Bronchoscopy was performed in 70% of patients. The mean number of investigations per patient was 4.4. The proposed management was surgery in 146 (23.5%), radiotherapy in 169 (27.2%), chemotherapy in 101 (16.2%) and supportive care in 202 (32.5%). The treatment intent was curative in 151 (24.3%) and palliative in 471 (75.7%). Patients who were considered suitable for curative treatment (135/151 referred for surgery) were younger, had better performance status, less weight loss, shorter history and inpatient stay. Follow up data was available in 566 patients (95%). 107 patients (16%) were alive 16 months after the completion of the registration period. The median survival for patients receiving treatment and completing follow up was 69.4 weeks for surgery (n = 124), 34 weeks for chemotherapy (n = 77), 30.4 weeks for radiotherapy (n = 167) and 6.7 weeks for supportive care (n = 174). Detailed analysis of presenting features, treatment and outcome is available and will be presented.

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survival in small cell lung cancer. Cancer Registry data of Norway Stein Kaasa,Palliative Medicine Unit, Department of Oncology, Tmndheim University Hospital, Norway. Steinar Thoresen, The Cancer Registry of Norway.

After the introduction of combination chemotherapy, a 5-6 fold increase in median survival and 5-81 of long term survivals have been reported. In most trials small study populations are included, and comparisons ars often done by the use of historical controls. No standard treatment of small cell lung cancer WLC) exists. The Cancer Registry of Norway have optimal data of all cancer diagnoses in Norway. Based on these data, survival analysis of patients diagnosed with SCLC from 1960 to 1989 have been performed.

From 1960 to 1969 the majority of the SCLC patients were treated with palliative radiotherapy to the thorax. From 1970 to 1975 with single dose Cycklofosfamide in a selected patient population, while combination chemotherapy was introduced in 1975. From 1975 to approximately 1980 combination chematerapy was used in a selected group of patients, while fmm 1980 to 1989 a standardized program for the treatment of SCLC was introduced in Norway, consisting of a Adriamycin, Cycklofoafamide and Vincristine. In the analysis patients were devidedinto groups according to years ofdiagnoses, i.e. 1960-64, 1965-69, following up until1985-89. The 5 years crude survival for SCLC were found to he identical during the entire study period, varying from 1.7% to 2,9%x No time trend were found for 5, nor for 2 and 3 years survival. An improved crude 1 year survival was found for the study period increasing from 12% (1960- 69) to 18 % (1985-89). When dividing the sample into limited and extensive disease, the time trend was only found for patients with limited disease, improving from 23% (1960-64), to 34% (1985-89). The 1 year survival for patients with advanced disease was approximately 6% for the entire study period.

Health related Quality of Life assessment. The EORTC approach. Stein Kaasa, Palliative Medicine Unit, Trondheim University Hospital, Norway, Bengt Bergman, Renstrwnska Hospital, Gateborg, Sweden, and the EORTC Study Group on Quality of Life.

The European Organization for Research and Treatment of Cancer (EORTC), Study Group on Quality of Life, has developed a modular approach for evaluating the quality of life (QOL) of patients participating in cancer clinical trials. The work is based on multinational and multicultural collaboration. Researchers from Europe, North Amerika and Asia are participating. A core questionnaire, the EORTC QLQ-C30 has been designed to measure health related QOL in a broad spectrum of cancer diagnoses. It incorporates five functional scales (physical, role, cognitive, emotional and social), three symptom scales (fatigue, pain and nausea/vomiting); and a global health/QOL scale. Several single symptom measures are also included. The EORTC QLQCSO has been validated in patient populations with non resectable lung cancer, patients receiving pallitive radiotherapy and in head and neck cancer patients. The questionnaire is well accepted by the patients, it requires 11-12 minutes to complete in average. The multitrait Beale analysis confirmed the hypothesized structure of the questionnaire in all studies. Diagnoses spesitic modules (subscales) are used to assess aspects of specific importance. Guidelines have been developed to standardize the module development and to test the validity. The module development consists of four phases: Generation of QOL issues, opsrationalisation of issues into a set of questions Wems), pretesting of the module and a large scale field testing. By using our approach, comparison between studies and cancer diagnoses can be facilitated through EORTC QLQ-C30 while diagnoses spesific issues will be covered by the use of a relevant module.

PREDICTABILITY OF BONE MARROW TOXICITY (EMT) IN CHEMOTHERAPY OF 8-L CELL LURG CARCER (SCLC). K. Bsterlind, A.G. Pedersen, P. Dombernowsky, M. Hansen & H.H. Hansen. Depts. of Oncology, Rigs- hospitalet (ONK) & Herlev University Hospital (R), and Medical dept. P, Bispebjerg Hospital. Copen- hagen, Denmark.

Hematological growth factor therapy (HGFT) can reduce the risk of life threatening leukopenia in chemotherapy of SCLC. To be effective treatment must be given prophylactically in all pts. Neither cost or inconvenience for the pts is negligeable and option criteria for this strategy is therefore warranted. Hoping to identify clinical determinants of BMT we analysed associations between pretreat- ment features and subsequent leukopenia (5 0.5) or thrombocytopenia (5 25) in a series of 373 pts, included in a randomized treatment trial between Oct. 1981 and Feb. 1985. Progressive disease + BMT were main causes of death in 49 pts dying during the first 30 days after initiation of chemotherapy. WBC ( 0.5 or platelet count ( 25 were observed in 22% of the remaining 324 pts and relationships to pretreatment anemia (< 12 g/dl), bone marrow met. (BM), abnormal LDH, hyponatremia (< 136 mM), age (2 65 yrs), sex, performance status (PS)(> 1) and a low body mass index (5 20) were investigated in 2x2 tables and in multivariate logistic regression (LR). Based on LR analysis: poor PS, LDH and high age were significantly related to risk of leuko- penia, while LDH and BM metastases increased the risk thrombocytopenia. These variables are well known prognostic factors and HGFT in these poor risk groups may reduce the risk of premature death but hardly improve the long term outcome in SCLC.