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Lung resection in patients aged ≥80 years is considered high risk and contributes to the low rates of resection in this population. This review of 79 octogenarians who underwent curative surgery for non-small-cell lung cancer demonstrated no intraoperative mortality, 30-day mortality of 1.3% and 12-month mortality of 10%. In this selected cohort of octogenarians, surgery resulted in acceptable short- to medium-term outcomes., (© 2021 Royal Australasian College of Physicians.)

Introduction: There is limited evidence whether decisions of Thoracic Multidisciplinary Meetings (TMDMs) are reflected in the treatment lung cancer patients actually receive. Aims were to determine concordance between TMDM recommendations for radiotherapy (RT) and actual RT administered and to compare cases that received RT that were referred or not referred from TMDMs., Method: A retrospective review of demographic and clinical data for all lung cancer cases within the Auckland-Northland region referred for RT from TMDMs (January-June 2009) and all cases that received RT but were not referred from TMDMs (January-August 2009)., Results: Of 110 cases referred for RT from TMDMs, 86 (78%) were offered RT (76 with the same treatment intent) and 78 (71%) received RT. Ten (9%) cases were deemed unsuitable for RT; 7 (6%) deteriorated; 4 (4%) declined or did not attend; 3% other. Fifty-one other cases received RT without TMDM presentation. Cases with remote domicile or recurrent disease were significantly less likely to have been presented at TMDMs. TMDM presentation did not significantly increase transit time to RT. The proportion of RT cases referred from TMDMs had increased substantially since 2004., Conclusion: The concordance between TMDM recommendations for RT and both the RT administered and the intent of treatment suggests a useful role for TMDMs. Concordance could be increased by improving RT timeliness and improved education of other disciplines and patients regarding the role of RT. Strategies to increase presentation at TMDM include attention to geographically isolated groups., (© 2012 The Authors. Journal of Medical Imaging and Radiation Oncology © 2012 The Royal Australian and New Zealand College of Radiologists.)

Background: Thoracic multidisciplinary meetings (TMDM) are a key component of lung cancer patient management. The optimal design, organisation and function of TMDM are uncertain, and different models may serve different purposes. In the Auckland/Northland region, there are two contemporaneous weekly TMDM using different formats; one is a co-located TMDM (C-TMDM), and the other is a video conference TMDM (V-TMDM) connecting different locations., Aims: To determine whether the rates of referral for radiotherapy (RT) and concordance between recommendations for RT and actual treatment received differed between the two TMDM formats., Method: A retrospective review of demographical and clinical data for cases referred for RT from both TMDM between January-June 2009 and the actual RT delivered., Results: Seventy-nine and 31 lung cancers were referred for RT from the co-located TMDM and the video conference TMDM respectively. While there were significant differences in demographics related to areas of domicile, there were no significant differences between the TMDM in (i) the proportion of cases referred for RT that received RT, (ii) the intent of treatment recommended by the TMDM and the intent of RT delivered, or (iii) transit times to commencement of RT between cases referred from the different TMDM., Conclusion: The similar results from the different formats of TMDM indicate that cases discussed with the use of e-health technologies are not disadvantaged with respect to recommended therapy nor in the appropriateness of decisions of the TMDM. Use of such technology may reduce the existing disparities in health outcomes between urban and rural patients., (© 2012 The Authors; Internal Medicine Journal © 2012 Royal Australasian College of Physicians.)

Background and Purpose: The intervention rate (IR) of radiotherapy (RT) is important for health service planning. As actual IRs are commonly lower than those predicted by models, we sought to determine the reasons for this discrepancy, using lung cancer in a mixed urban-rural region of New Zealand (NZ)., Methods: The appropriate utilisation of RT was calculated as the sum of the actual utilisation 3 years post diagnosis (88% of cases deceased), the estimated utilisation of the 12% remaining alive, and the percentage of cases that may have benefited from RT but did not receive it., Results: The actual utilisation was estimated as 43% (range 40-48%). A further 8% of deceased cases may have benefitted from RT (but were not referred), giving an appropriate utilisation of 51%. An additional 3.5% that may have benefitted from RT declined management. The difference from modelled IRs was due to a combination of early mortality, refusal of treatment and assumed higher RT treatment rates for many clinical scenarios., Conclusion: The appropriate utilisation of RT was substantially lower than IRs derived from models. The assumptions from which these models were derived may result in over-estimates for resource planning purposes.

Background: The previous study established that lung cancer patients in Auckland-Northland most commonly presented to secondary care through the emergency department (ED)., Aim: To further explore the characteristics and presentation of cases presenting through EDs in Auckland., Methods: Data were collected for all lung cancer cases (2004) in Auckland that initially presented to secondary care via ED RESULTS: Of (478) lung cancer cases diagnosed in Auckland in 2004, 170 cases (36%) presented via ED. ED presentation varied with tumour stage (p<0.0005), ethnicity (p=0.01), and DHB (p=0.004). Of the patients presenting to ED for whom records were available (159; 94%): 107 (67%) had respiratory symptoms; 66 (42%) were GP-referred; of these, 22 had had a CXR; 6 (4%) were already under respiratory surveillance; and 11 (6%) had previously been seen by secondary care regarding the presenting symptoms. All cases (except 1) were admitted. GP referral varied across DHBs (p=0.04) and ethnic groups (p=0.02). Age, gender, and tumour type were not associated with ED presentation., Conclusion: Lung cancer patients, especially those of Pacific ethnicity, commonly presented as emergencies, often by-passing primary care. This suggests barriers to, or within, primary care and further research is required to explore the reasons underlying these findings.

Background: Lung cancer survival statistics for New Zealand (NZ) are poor relative to Australia, USA, Canada and some European countries for reasons that are unknown. As patients with early-stage non-small-cell lung cancer (NSCLC) have the highest chance of survival, appropriate management disproportionately influences survival rates. The aim of this study was to assess management of stage I/II NSCLC, whether management differed from international practice, and factors influencing curative management., Methods: Management of patients with stages I and II NSCLC was determined from an audit of secondary care in Auckland and Northland for patients with lung cancer diagnosed in 2004 (565)., Results: Of the 142 cases with stage I or II NSCLC, 79 patients (56%) were treated with curative intent and 61 (44%) were managed palliatively. Of those treated curatively, 69 underwent surgical resection, 9 received definitive radiation therapy and a single patient received concurrent chemo-irradiation. Of those managed palliatively, 21 received anticancer treatment and 40 received supportive care. Increasing age and comorbidity reduced the chances of receiving curative treatment (P < 0.001, P = 0.004, respectively); however, discussion at a multidisciplinary meeting was associated with increased likelihood of curative management (P < 0.001). Disparity between NZ and overseas practice increased with increasing age and comorbidity. Only half of those managed curatively commenced treatment within internationally recommended time frames., Conclusion: Relatively fewer patients received potentially curative treatment in this NZ study than in countries with better survival outcomes and many were not managed within recommended time frames. Management differences increased with increasing age and comorbidity, possibly suggesting more nihilistic attitudes in NZ.

Background: Despite the importance of New Zealand Cancer Registry (NZCR) data to research and healthcare decision-making, there has been no previous assessment of the accuracy of NZCR data since mandatory reporting commenced in 1994., Aim: To assess the completeness and accuracy of NZCR lung cancer data., Method: An audit of secondary care management in Auckland and Northland of lung cancer patients diagnosed in 2004 provided the opportunity to compare data from regional databases (RD) with NZCR data., Results: Of 565 audit cases, 66 cases (12%) were not included on the NZCR listing. The NZCR listing included 9 eligible cases not identified by RD, 1 duplicate registration and 78 (13%) ineligible cases. Few differences occurred in demographic or tumour details for the 490 cases common to both listings. Tumour staging was available for 97% of cases in RD, and disease extent was recorded for 58% in the NZCR. The latter was more likely to be missing for cases with locally advanced disease (p<0.001), older age (p<0.001), or comorbidity (p<0.001)., Conclusion: Use of the NZCR alone would have reduced accrual by 12%; disease extent was absent for 42% with a systematic bias towards being unknown for cases with locally advanced disease. Use of NZCR data without recognition of this bias could lead to inappropriate conclusions. Those using NZCR data should be aware of its definitions, methodology and limitations.

Background: Major ethnic disparities in lung cancer survival exist in New Zealand, with Mäori having a higher case-fatality ratio than non-Mäori., Aim: To assess whether secondary care management of lung cancer differed by ethnicity and could contribute to ethnic survival disparities., Methods: An audit of secondary care management in Auckland and Northland of lung cancer patients diagnosed in 2004 permitted comparison of the management of lung cancer in different ethnic groups., Results: The 565 eligible cases comprised: European 378 (67%), Mäori 95 (17%), Pacific Peoples 56 (10%), Asian 23 (4%), and other or unknown ethnicity 13 (2%). In multivariate analysis (adjusting for tumor and patient factors including comorbidity), Mäori were 2.5 times more likely to have locally advanced disease than localized disease compared with Europeans (p < 0.01), and four times less likely to receive curative rather than palliative anticancer treatment compared with Europeans (p < 0.01). Mäori had longer transit times from diagnosis to treatment (p < 0.001). Mäori were more likely to decline treatment and miss appointments than Europeans, although this only partially explained management differences., Conclusion: Multiple factors are potentially responsible for the higher case-fatality ratio in Mäori. Such factors include presentation with more advanced disease, lower rates of curative treatment for nonmetastatic disease, and longer transit times from diagnosis to treatment. In this retrospective study, socioeconomic deprivation, comorbidity levels, and failure to accept treatment did not fully explain ethnic differences in management. Further assessment of the underlying issues by prospective evaluation is warranted.

Introduction: The survival of patients with lung cancer in New Zealand is poor compared with Australia and the United States. To determine whether these poorer outcomes were related to secondary care management or to other factors, we documented stage of disease, comorbidities, and initial secondary care management for patients diagnosed with lung cancer in 2004, in Auckland and Northland (New Zealand). These data were compared with international data., Methods: Cases were identified from regional databases and the New Zealand Cancer Registry. Patient, tumor, and management details were collected from clinical records., Results: Five hundred sixty-five eligible cases were identified: 55% were male, the median age was 69 years, 9% were never-smokers, 81% had documented comorbidity, and 32% belonged to the most deprived socioeconomic quintile. Histopathology was non-small cell lung cancer (NSCLC) in 70%, small-cell lung cancer (SCLC) in 13%, 2% other types, and 15% clinicoradiological diagnoses. At presentation, 70% of NSCLC cases had locally advanced/metastatic disease, and 65% of SCLC cases had extensive disease. Overall, 70% of cases were referred to an anticancer service, and 50% received initial anticancer treatment. Potentially curative treatment was received by 20% of cases: 56% stage I/II, 10% stage III NSCLC, and 58% limited-stage SCLC., Conclusions: This cohort was characterized by high comorbidity and advanced disease. Although similar to the United Kingdom, initial treatment rates were low in comparison with Australia and the United States, despite similar stage distributions. Overall, 50% of patients, including 30% with early-stage disease, did not receive initial anticancer treatment. Low anticancer treatment rates may contribute to poorer survival outcomes in New Zealand.

Objective: The aim of this study was to define the clinical and pathological features associated with lung cancer diagnosed in persons under the age of 45 compared with lung cancer in an older population of greater than 45 years., Methodology: A case control study was undertaken. Cases were defined as patients diagnosed with lung cancer under the age of 45 years. Controls were lung cancer patients over 45 years matched only for the date of diagnosis. Up to four controls were selected for each case. A retrospective review was undertaken of the records of a single tertiary respiratory institution which served a population of 1.2 million., Results: Forty-eight cases of lung cancer (< 45 years of age) were identified and were compared to 123 matched controls with lung cancer (> 45 years of age). Of the cases 67% were female compared with 32% female cases in the control group (P < 0.01). The rate of adenocarcinoma was significantly higher among cases (48% vs 27%, P=0.001), while squamous cell carcinoma was more common in the controls (35% vs 17% P =0.001). Smoking was common in both groups although less so among cases (79% vs 95%, P=0.001)). There was no difference in survival rates between the cases (11 months) compared with controls (8 months) (P=0.1)., Conclusions: Young lung cancer patients were predominantly female and adenocarcinoma accounted for a disproportionate number of the histological types. Cigarette smoking appears to be the main aetiological agent but as 21% of the patients under 45 years were non-smokers, other factors (genetic/hormonal) may also contribute. This study has not demonstrated a worse outcome in younger patients.