Volume 5, Number 2

Clare Green MBBS MRCP Consultant Clinical Oncologist, Southampton General Hospital; Julie Adams RGN Chemotherapy Ward Manager; Suzanne Elvin BPharm(Hons) MRPharmS CertPharmPrac IP Technical Services Manager – Pharmacy, Royal Hampshire County Hospital, Winchester

Demand for cancer drugs is growing rapidly at around 15–20% per year, driven by more patients receiving treatment and exacerbated by the fact that many targeted agents, which are time-consuming to prepare and administer, are given in addition to chemotherapy drugs.

Michael D Peake, Editor

When I first became interested in lung cancer almost 30 years ago, life was relatively simple! Diagnosis was most often based on chest X-ray and bronchoscopy alone and the treatment options were few: for those with early stage non-small cell lung cancer (NSCLC), surgery was available for the fit patients and conventional radical radiotherapy for those deemed unfit; there was chemotherapy for fit small cell lung cancer (SCLC) patients and palliative radiotherapy for symptom control.

Robert Rintoul PhD FRCP Consultant Chest Physician, Papworth Hospital, Cambridge

Accurate staging of lung cancer is essential in order to optimise treatment. In non-small cell lung cancer (NSCLC) it is recognised that stage at presentation is a strong predictor of survival. NSCLC usually metastasises initially via the lymphatic system to locoregional lymph nodes (hilar and mediastinal) and subsequently to distant organs by haematogenous spread.

Rafaelle Califano MD Clinical Research Fellow in Medical Oncology; Fiona Blackhall MRCP PhD Consultant in Medical Oncology and Honorary Senior Lecturer, Department of Medical Oncology, Christie Hospital NHS Foundation Trust, Manchester

Lung cancer is the most common cause of cancer death worldwide and the non-small cell lung cancer (NSCLC) histological subtype accounts for 85% of cases. Most patients present at an advanced, inoperable stage for which there is no prospect of cure and a median survival of only four months with best supportive care. Palliative treatment aims to improve symptoms, optimise quality of life (QoL) and prolong survival. It took several decades of clinical trials that included detailed QoL analyses to convince physicians that the benefits of chemotherapy can outweigh potential side-effects in treating advanced NSCLC.

David R Baldwin MD FRCP Consultant Physician, Respiratory Medicine Unit, David Evans Centre, Nottingham University Hospital, Nottingham

‘How long has it been there?’ is a question often asked by patients or their relatives and one that leads to discussion about exactly when symptoms developed and how they were managed. The patient is usually concerned about whether the delay has affected the chance of cure. The question is relatively easily answered, but the underlying concern less so.

Pooja Jain MRCP FRCR Consultant Clinical Oncology, Clatterbridge Centre for Oncology, Wirral; Carl Graham Rowbottom PhD Northwestern Medical Physics; Corrine Faivre-Finn FRCR MD PhD Honorary Senior Lecturer and Consultant Clinical Oncology, Christie Hospital, Manchester

Lung cancer is the second most common malignancy affecting the UK population. Non-small cell lung cancer (NSCLC) accounts for 80% of all lung cancers. Surgery is the treatment of choice for stage 1 and some stage 2 cancers. However, surgical resection rates are still low, at around 10% in the UK.