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NEWS: Susan Mayor Audit shows quality of lung cancer treatment in UK lags behind other countries BMJ 2009; 338: b1830 [Full text]

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Are the results valid?

Alexander Spiers   (10 May 2009)

Are the results valid? 10 May 2009
Alexander Spiers, Professor of Medicine (retired). SL6 9TR Send response to journal: Re: Are the results valid?	It is praiseworthy that there have been three National Lung Cancer Audits. It is pleasing that the proportion of lung cancer patients receiving any active anticancer treatment has increased from 43% to 51% between 2005 and 2007. Even better is the finding that 87% of patients were reviewed by a multidisciplinary team. But are the national and international comparisons of performance at various centres valid? Differences in performance are affected by numerous factors. A low resection rate at one centre may mean that more patients presented with advanced disease, or that thoracic surgeons at that centre were too few or overly conservative. On the other hand, it may be the result of more careful staging, so that noncurative resections are avoided. In Italy, the treatment rate of 75% and the resection rate of 25% may indicate better management, but this is not ecessarily so; it could indicate an excess of enthusiasm. It is more important to compare survival rates and cure rates at different centres and in different countries - i.e. to determine whether more treatment equates with better outcomes. The conclusions of the Third Audit - that the situation is improving but there is room for much further progress - is undoubtedly true. Competing interests: None declared