Christmas Tim, Findlay Michael
Green Lane Hospital, Auckland, New Zealand.
N Z Med J. 2004 Jun 18;117(1196):U931.
To determine treatment practices of New Zealand physicians who manage non-small cell lung cancer (NSCLC).
A questionnaire on the treatment of NSCLC was emailed to all respiratory physicians, medical oncologists, and radiation oncologists in New Zealand. Respondents were asked to select the treatment they would offer in six lung cancer case scenarios.
Thirty-one (81%) respiratory physicians, 15 (71%) medical oncologists, and 8 (30%) radiation oncologists responded to the questionnaire. Surgery was selected (by all groups) as the best option for early-stage disease NSCLC. Radiotherapy or combination chemo/radiotherapy (for locally advanced disease) was favoured by 37% of respiratory physicians for stage IIIa and 28% for stage IIIb--compared with medical oncologists (100% and 80%) and radiation oncologists (86% and 28%). Chemotherapy for 'fit' patients with advanced disease was favoured by only 11% of respiratory physicians, compared with 67% of medical oncologists and 33% of radiation oncologists. Best supportive care (BSC) was the favoured treatment for patients with advanced disease with poor performance patients.
This study demonstrates considerable heterogeneity in the choice of treatment for NSCLC between specialities, particularly for locally advanced and advanced disease. These findings suggest international guidelines are not being adhered to, and variations in treatment may potentially have outcome implications for patients.
确定新西兰治疗非小细胞肺癌（NSCLC）的医生的治疗方法。
向新西兰所有呼吸内科医生、肿瘤内科医生和放射肿瘤医生发送了一份关于NSCLC治疗的调查问卷。要求受访者在六种肺癌病例场景中选择他们会提供的治疗方法。
31名（81%）呼吸内科医生、15名（71%）肿瘤内科医生和8名（30%）放射肿瘤医生回复了问卷。手术（所有组）被选为早期NSCLC疾病的最佳选择。对于Ⅲa期，37%的呼吸内科医生倾向于放疗或联合化疗/放疗（用于局部晚期疾病），Ⅲb期为28%——相比之下，肿瘤内科医生分别为100%和80%，放射肿瘤医生分别为86%和28%。对于“适合”的晚期疾病患者，只有11%的呼吸内科医生倾向于化疗，相比之下，肿瘤内科医生为67%，放射肿瘤医生为33%。最佳支持治疗（BSC）是身体状况较差的晚期疾病患者的首选治疗方法。
本研究表明，不同专业在NSCLC治疗选择上存在相当大的异质性，特别是对于局部晚期和晚期疾病。这些发现表明未遵循国际指南，治疗差异可能对患者的预后产生影响。
