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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.