Is the treatment of lung cancer in Norway adequate?

Almost 2,000 new cases of lung cancer are reported in Norway every year. Only 16-17% are operated upon with resection. Over the 1995-98 period, 1,035 not resected cases with localized lung cancer were reported to the Cancer Registry of Norway; 166 cases were excluded for various reasons. Records from the Cancer Registry with additional information from clinicians were revised by the authors with regard to staging and operability. Of 869 evaluable patients, 386 were inoperable due to advanced disease, and in 86 the situation was not adequately clarified. Of the remaining 397, 270 were classified as being operable and 127 possibly operable. Of the operable patients, small cell lung cancer was considered as the sole contraindication to surgery in 61 patients despite being in stage 1. Poor lung function was noted as contraindication to surgery in 50 patients. However, most of them were inadequately investigated. In 124 patients one or more other risk factors were considered as contraindications, but the impact of some of them seemed to have been overestimated. The study showed that the information about stage routinely submitted to the Cancer Registry was unsatisfactory. We believe that more patients with localized disease in the present series should have been operated on.