B107
Delivering adjuvant chemotherapy in non-small cell lung cancer (NSCLC): the experience from a regional thoracic unit
Mariam Jafri, Katy Gines, Joyce Thompson
Birmingham Heartlands Hospital, Birmingham, West Midlands, UK
Background
Cisplatin based adjuvant chemotherapy confers a 5.4% absolute survival benefit and should be considered in all patients who undergo a curative resection. However, in practice not all patients are considered for or receive chemotherapy. Development of network guidelines can increase uptake, we re-audited the uptake of adjuvant chemotherapy in NSCLC after the development of network guidelines.
Method
All patients referred from 6 hospitals undergoing curative resection for lung cancer between August 2006 and August 2008 were identified using a central pathology database. Medical notes were analysed to identify: demographics, staging information, date of operation, comorbidities and whether they were referred to an oncologist. Oncology pharmacists were contacted to determine whether patients received chemotherapy and the regime utilised.
Results
116 patients were identified aged 44-83 (median age 66). 75 males and 41 females were treated. 60% of patients were referred to an oncologist for consideration of adjuvant chemotherapy and 53% of these received adjuvant chemotherapy. The commonest reasons for non-referral for consideration for adjuvant chemotherapy were stage 1A, death postoperatively or neo-adjuvant chemotherapy for downsizing. The commonest reasons for non-treatment were patient co-morbidity and age over 75. The most common treatment regime was cisplatin and gemcitabine. 71% of patients received a cisplatin doublet, however 29% received gemcitabine and carboplatin.
Conclusion
Most patients are being referred for the consideration of adjuvant treatment, with only a minority (5%) with no clear reason for non-referral. Most patients were treated appropriately with cisplatin, carboplatin use was limited to one clinician. Delivery of adjuvant chemotherapy is improving, however further efforts are needed to improve the uptake of adjuvant chemotherapy.
