Lung cancer treatment cited for high death toll

By REBECCA WALSH

Differences in the way New Zealand doctors treat lung cancer and a reluctance by some to use aggressive therapies such as chemotherapy could be contributing to the country's low survival rates, a study has found.

The five-year survival rate for the most common type of lung cancer (non-small cell lung cancer) is about 5 per cent, compared with 11 per cent in Australia and 14 per cent in some European countries.

Research published in the New Zealand Medical Journal found differences in the way New Zealand specialists treat lung cancer. It suggested international guidelines for treatment were not being followed.

An editorial in the same issue described New Zealand lung cancer services as "sub-optimal". It said a diversity of opinion existed about which treatments were available and who should be offered them.

Respiratory physicians, medical oncologists and radiation oncologists were asked what treatment regime they would follow for six hypothetical patients.

While there was agreement that surgery was the most appropriate treatment for early stages of the disease, the researchers found big differences in the treatment preferences between specialties in cases where the cancer was more advanced. Respiratory physicians tended to be more conservative in their treatment.

Researcher Dr Tim Christmas, a respiratory physician at Green Lane Hospital, said the reluctance to offer chemotherapy may be due to the commonly held belief that lung cancer is a "[self-inflicted] disease of the elderly, which precludes them from chemotherapy".

The failure by respiratory physicians to offer chemotherapy could reflect scepticism about its benefits, he said.

Dr Christmas said although there were no specific New Zealand guidelines, the Australian Cancer Network guidelines - contributed to and endorsed by the Thoracic Society of Australia and New Zealand - recommended chemotherapy, radical radiotherapy and a combination of treatments for some patients with advanced disease.

Dr Christmas said countries that had adopted more aggressive treatment policies appeared to have greater survival rates.

But Dr Margaret Wilsher, clinical leader of cardiothoracic and vascular services at Auckland City Hospital, said the issue was partly due to resources. The drugs were very expensive and the benefits not particularly striking.

"You are adding a very small number of months on average at considerable toxicity. Many clinicians would think twice about using the drugs ... because they are not necessarily enhancing quality of life."

Dr Wilsher said some patients, particularly older patients and Maori and Pacific people, did not want chemotherapy.

Survival rates for lung cancer were low around the world but New Zealand's more conservative approach and ethnic make-up (the Maori population has a higher prevalence of smoking) could account for some of the difference, she said.

Dr Wilsher supported national guidelines to ensure patients had the same access to treatment but said New Zealand did not want a situation like that in North America, where people were kept alive an unnaturally long time on ventilators and "flogged to death with powerful chemo-therapeutic agents".