Lung cancer is the largest cause of cancer death in New Zealand, accounting for 18.3% of cancer-related deaths.[[1,2]] There is limited literature on how patients with lung cancer clinically present in New Zealand. The aim of this cohort study was to identify the rate of incidentally diagnosed lung cancer in the Midland Region, the common symptomatology and route of diagnosis. This retrospective cohort study included patients with lung cancer who underwent potentially curative thoracic surgery between January 2011 to June 2018 at Waikato Hospital, New Zealand. Symptoms or signs recorded were cough, dyspnoea, haemoptysis, lymphadenopathy, chest pain, hoarseness, fatigue, weight loss and finger clubbing. The lung cancer cases were grouped into incidental finding, symptomatic general practitioner, symptomatic emergency department and surveillance. Three hundred and ten patients with lung cancer had thoracic surgery with curative intent at Waikato Hospital. Two hundred and fourteen (69%) patients had symptoms which prompted presentation to a treating physician and 96 (31%) patients were asymptomatic. Incidental diagnosis was demonstrated in 121 (39.4%) patients. Of the patients diagnosed incidentally, 36.4% (n=44) had symptoms of lung cancer with the main symptoms including 45% with cough (n=20), 28% with dyspnoea (n=12) and 28% chest pain (n=12). In New Zealand, a large amount of lung cancer is still diagnosed incidentally with symptoms of cough, dyspnoea and chest pain. Further research into the development of a lung cancer screening program in New Zealand for a high-risk population is warranted.
Lung cancer is the leading cause of cancer-related death in Aotearoa New Zealand and a major contributor to health inequities, particularly among Māori and Pacific peoples. Despite declines in smoking prevalence, lung cancer incidence remains high. Detailed projections are needed to inform future cancer service planning and support cancer control strategies. An age-period-cohort Poisson regression model was fitted to national cancer registry data (2001-2022), stratified by sex, prioritised ethnicity, age group and Health New Zealand - Te Whatu Ora region. Time-based weighting and non-parametric bootstrapping were used to derive projections and uncertainty intervals to 2045. Annual lung cancer cases are projected to increase by 38.3%, from 2,544 in 2020-2022 to 3,519 in 2045 (95% uncertainty interval [UI] 3,275-3,771), despite a decline in the age-standardised rate from 28.2 to 23.6 per 100,000 (95% UI 21.6-25.7). Substantial ethnic inequities persist. Māori cases are projected to rise from 570 to 1,063 (an 86.5% increase), and Pacific cases from 129 to 245 (an 89.9% increase). Although rates are projected to fall across all groups, Māori are expected to continue to experience the highest rates. Regional variation is also evident, with the Northern Region projected to experience the largest increase in case numbers, from 872 to 1,280 by 2045. Although age-standardised incidence rates are expected to decline, rising case numbers indicate growing demand for diagnostic and treatment services. These projections support the need for equitable implementation of lung cancer screening and sustained investment in culturally responsive prevention and cessation support.
Lung cancer causes more deaths than any other cancer, globally and in Aotearoa New Zealand, where it disproportionately affects Māori. We aimed to understand Māori perspectives on lung cancer screening in Aotearoa New Zealand to guide its equity-focussed implementation, including identifying enablers and barriers. We took a Kaupapa Māori based co-design approach to inform future screening, recruiting Māori current/ex-smokers and members of their whānau (family) for three focus group phases held in Auckland, Aotearoa New Zealand in August 2019. Participants responded to a proposed lung cancer screening pathway and shared their attitudes and beliefs about lung cancer and screening. Results were thematically analysed. The 21 Māori participants supported future lung cancer screening in Aotearoa New Zealand. Perceived benefits included being more informed about lung cancer and screening and enabling healthier future generations. Barriers to screening were previous negative health service experiences; fear; stigma; and access, including time, cost and transport. Enablers included providers' cultural competence; clear communication; a one-stop shop; and support with transport. A range of factors could potentially influence a decision to participate in screening. Participants favoured future lung cancer screening and identified key barriers and facilitators of screening.
Lung cancer is the most lethal cancer for Māori in Aotearoa New Zealand, with more Māori dying from lung cancer each year than the next five most common causes of cancer death combined. Māori have far poorer lung cancer survival outcomes than our majority European population, and access to timely, best-practice diagnosis and care could be an important driver of these disparities. We recently conducted a nationwide project to augment existing evidence and identify points along the clinical pathway where there are ethnic differences in access to this care. We found some cause for cautious celebration, including equitable access to bronchoscopy, pathological diagnosis, radiation therapy and systemic therapy, as well as minimal differences in the timing of treatment between ethnic groups. However, we identified a number of disparities along the treatment pathway that require intervention, including higher emergency presentation rates, poorer access to early detection, lower surgery rates and disparities in the distance required to travel to bronchoscopy, surgery and radiation therapy. Based on our observations from this project, along with the context provided by literature review and discussions with stakeholders, we have made five recommendations for areas of action to address these disparities, with a view to ultimately improving survival outcomes for Māori. Our results suggest that it is possible to achieve equitable outcomes for Māori in key areas; we must now push forward toward closing further gaps if we are to achieve equity in lung cancer survival for our Indigenous peoples.
We aimed to assess the frequency of systemic anti-cancer therapy (SACT) use in patients with advanced non-small cell lung cancer (NSCLC), comparing Māori and non-Māori. Secondary aims were to assess predictive factors for patients managed with SACT, SACT agent regimens and lung cancer-specific mortality. A retrospective cohort study of patients with incident advanced NSCLC in the Aotearoa New Zealand Midland Region between 1 January 2011 to 31 December 2021 was undertaken. Data were primarily derived from the Midland Lung Cancer Registry. The study cohort comprised 2,549 patients with incident advanced NSCLC. A total of 775 patients were Māori (30%). SACT was received by 942 patients (37%). There was no difference in overall SACT rate between Māori and non-Māori: adjusted odds ratio (OR) 0.88 (95% confidence interval [CI] 0.71-1.09), p-value >0.05. For patients who received SACT, Māori were less likely to receive targeted therapy first-line (8.5% vs 16.1%, p-value <0.01). Māori had higher cancer-specific mortality: adjusted OR 1.19 (95% CI 1.08-1.32), p-value <0.001. In this pre-funded immunotherapy era, no difference was observed in overall SACT rate for Māori patients with advanced NSCLC. Māori were less likely to receive targeted therapy first-line, for which the underlying reasons require investigation. Our data suggest other factors, beyond overall SACT use rate, influence the higher cancer-specific mortality in Māori.
This research examines the characteristics and survival outcomes of patients receiving a lung cancer diagnosis after attending the emergency department (ED) of Waikato hospitals in New Zealand. This retrospective study was based on a comprehensive database of Waikato patients recorded on the Midland Lung Cancer Register from 2011 to 2021. We compared the characteristics of patients with and without emergency presentations within 14 days before their lung cancer diagnosis. The survival of patients with and without ED attendance was compared between Māori and non-Māori. This study also analysed the odds ratios (OR) of presenting via ED before diagnosis and surviving 12 months based on logistic regressions. In total, 2,397 patients were included, with 39.6% attending the ED prior to diagnosis. Māori were 1.27 times more likely than non-Māori to be diagnosed after attending the ED. Other characteristics of patients included being male, being diagnosed with small cell lung cancer and having more advanced-stage disease. Patients attending the ED were less likely to survive 12 months than those without ED visits (OR 0.42), and those with two or more ED visits were even less likely to survive 12 months (OR 0.33). Patients presenting through the ED have more advanced-stage disease, while those presenting through their general practitioners (GPs) have evidence of being diagnosed earlier and having better survival. Barriers to early diagnoses through attendance with a GP, particularly for Māori and for men, need to be explored.
The purpose of this article is to examine disparities in the impact of the COVID-19 pandemic on access to lung cancer diagnosis and access to clinical services between Māori and non-Māori. Using national-level data, we examined age-standardised lung cancer registrations, diagnostic procedures (bronchoscopy) and lung surgeries separately by ethnic group for the years 2018-2020, as well as patterns of stage of diagnosis. We found a trend toward a reduction in rates of lung cancer registration in Māori (but not non-Māori/non-Pacific) New Zealanders in 2020 compared to 2018 and 2019, but no apparent shift in the distribution of stage at diagnosis. We found a trend toward a reduction in rates of bronchoscopy for both Māori and non-Māori/non-Pacific patients, with the largest reduction observed for Māori. Rates of lung cancer surgery appeared to have reduced for Māori patients, although this was based on a small number of procedures. We observed disparities between Māori and non-Māori/non-Pacific patients in lung cancer registration and bronchoscopy as a result of the COVID-19 pandemic.
Māori are less likely to survive their lung cancer once diagnosed, but it remains unclear whether this is partially driven by poorer access to best-practice diagnostic services. We examined all lung cancer registrations in Aotearoa New Zealand between 2007-2019 (n=27,869) linked to national administrative health datasets and further stratified by ethnicity, tumour type and stage of disease. Using descriptive and regression analyses, we compared ethnic groups in terms of the basis of diagnosis (e.g., histology, cytology), receipt of bronchoscopy and travel distance and time to access bronchoscopy. We found no differences in access to a pathological diagnosis between ethnic groups regardless of cancer type or stage. We found that Māori within the cohort were marginally more likely to access bronchoscopy than the majority European group; however, we also found that Māori had lower odds of living close to the location of their bronchoscopy, and correspondingly higher odds of living 100-200km (adjusted odds ratio [adj. OR] 1.46, 95% confidence interval [CI] 1.26-1.69) or more than 200km away (1.36, 95% CI 1.15-1.61) than Europeans. Interventions that aim to further support Māori to overcome the systematic and cumulative disadvantages in access to cancer care should be broadly supported and resourced.
To determine the patient characteristics, referral patterns and delays in assessment and treatment of patients with primary lung cancer in South Auckland, New Zealand and compare with international standards. Retrospective review of the clinical records of 80 patients referred to a secondary care respiratory service and diagnosed with primary lung cancer in 2004. Eighty-five percent of inpatient referrals and 48.5% of outpatient referrals were for advanced stage lung cancers. The median interval from receipt of outpatient referral to first chest physician assessment was 18 days, with median interval from the first chest physician assessment to bronchoscopy of 17 days and for staging CT chest of 16 days. For patients requiring a CT-guided percutaneous needle aspiration for diagnosis, there was a further median delay of 37 days after the initial CT scan. The median interval from the date of receipt of initial outpatient referral to diagnosis was 38 days, but for early stage lung cancers it was 54 days. The median interval to diagnosis for inpatient admissions was 6 days after the first respiratory assessment. The intervals for initial assessment, diagnosis and treatment of lung cancer in South Auckland do not meet the recommendations of international guidelines, especially for early stage lung cancers. Organisational and resource changes are required at each point in the diagnostic and management pathway to reduce delays.
As part of a broader lung cancer screening (LCS) research programme, this study explored Māori views on providing blood samples for LCS to inform future development in Aotearoa New Zealand. Two groups (potential "screenees", and their whānau tautoko [support people]) from Te Tai Tokerau (Northland) and Tāmaki Makaurau (Auckland) completed surveys about LCS design, including comfort with blood donation and key factors in blood collection and use. Descriptive statistics and Fisher's tests were used to analyse responses and demographic differences. Most participants (83.7% screenees; 81.4% whānau) were at least "comfortable" donating blood. Key priorities were clear information about blood use (35.0%; 35.8%), protecting the health of future generations (24.1%; 23.8%) and being able to consent to specific uses (23.6%; 27.6%). Participants from Te Tai Tokerau were less comfortable donating blood than those in Tāmaki Makaurau, with additional demographic differences noted. Māori participants generally supported using blood samples in LCS but with regional differences. Future LCS initiatives should uphold Māori principles, including community partnership, return of benefit to whānau, management of potential harms and protection of Indigenous data and tissue sovereignty through transparent, culturally safe and trusted engagement processes.
To characterise patients with non-squamous, non-small cell lung cancer (NSCLC) diagnosed at Counties Manukau District Health Board (CMDHB; South Auckland, New Zealand) to estimate the number who may be eligible for EGFR mutation testing. Retrospective review of clinical records of 206 patients diagnosed at CMDHB with primary lung cancer between 01/07/2011 and 30/06/2012 RESULTS: Of the 206 patients, 141 (68.4%) had non-squamous, non-small cell lung cancer (NSCLC). Of these 141 cases: 87 (62%) were adenocarcinomas; 73 (51.8%) were male; 78 (55.3%) were European, 16 (18.4%) were Pacific Islanders, 22 (15.4%) were Maori and 15 (10.7%) were Asian, with nine being from South East Asia; 28 (19.9%) had never smoked; 103 (73.0%) had advanced cancer (stage IIIA or more advanced); and 112 (79.4%) cases had an ECOG performance score of two or less. There were four patients with advanced adenocarcinoma who were South East Asian females and had never smoked, all of whom had an ECOG performance score of less than two. In a 1-year cohort of primary lung cancer patients, 68% had non-squamous, NSCLC and were potentially eligible for EGFR mutation testing. Patients with advanced stage, non-squamous NSCLC comprised half of all lung cancer patients.
to describe the epidemiology of new cancer registrations among Pacific Island people in New Zealand with a view to identifying important cancers for preventive activities. new cancer cases registered with the New Zealand Cancer Registry of the Health Statistical Services for the decade 1979-88 were analysed. Cancer cases among Pacific Island people were compared with cancer cases among Maori and the remainder of the New Zealand population (other). while the number of cases reported among Pacific Island people was relatively small (1884), age standardised rates for cancer of all sites were much higher than age standardised rates for Maori and other populations. The age standardised rate (per 100,000 person years) for cancer of all sites among males in all age groups was 400 for Pacific Island, 308.8 for Maori and 295.3 for others. The age standardised rate for cancer of all sites among women in all age groups was 373.3 for Pacific Island women, 324.2 for Maori and 313.4 for other women. Liver cancer was more common among Pacific Island men than could be explained by temporary migration from the Pacific Islands for treatment. The age standardised rate for liver cancer was 28.2 for Pacific Island men, 11.4 for Maori and 1.9 for other men. Cancer of the cervix was the leading site among Pacific Island women as in Maori women, compared with breast cancer among women in the rest of the population. The age standardised rate for cervical cancer was 61.8 for Pacific Island, 69.0 for Maori and 59.3 for other women. in the decade 1979-88 there was an excess number of new registrations for some cancers described among Pacific Island people compared with Maori and other ethnic groups. Temporary migration from the Pacific Islands for treatment may explain some of the excess cases.
This article reviews recent developments with the use of adjuvant chemotherapy for resected early-stage non-small cell lung cancer (NSCLC) and the implications of these developments for healthcare in New Zealand (NZ). Non-small cell lung cancer is a major cause of mortality and morbidity in NZ, and is greatly over-represented among Maori and socioeconomically deprived populations. Early-stage NSCLC is potentially curable by surgery, but long-term outcome after surgical resection is limited by disease recurrence locally or at sites distant from the primary disease. Three recent large randomised controlled phase III trials using modern platinum-based combination chemotherapy protocols have shown significant survival benefits for the use of postoperative adjuvant chemotherapy after resection of early-stage NSCLC. Cisplatin plus vinorelbine was used as the adjuvant chemotherapy regimen in two of these trials resulting in improvements in 5-year survival of 51.2% versus 42.6% (p=0.013) and 69% versus 54% (p=0.03), respectively. In NZ, adjuvant chemotherapy for NSCLC is expected to prevent up to 15 lung cancer deaths each year for relatively low drug expenditure and has the potential to benefit Maori and the economically-deprived disproportionately more than other populations. In conclusion, it is the opinion of this group of NZ lung cancer specialists that adjuvant chemotherapy with cisplatin plus vinorelbine should now be adopted as a standard of care for patients with resected stage II and III NSCLC. For this to occur, current PHARMAC policies preventing its use for these eligible patients will need to be revised.
The previous study established that lung cancer patients in Auckland-Northland most commonly presented to secondary care through the emergency department (ED). To further explore the characteristics and presentation of cases presenting through EDs in Auckland. Data were collected for all lung cancer cases (2004) in Auckland that initially presented to secondary care via ED RESULTS: Of (478) lung cancer cases diagnosed in Auckland in 2004, 170 cases (36%) presented via ED. ED presentation varied with tumour stage (p<0.0005), ethnicity (p=0.01), and DHB (p=0.004). Of the patients presenting to ED for whom records were available (159; 94%): 107 (67%) had respiratory symptoms; 66 (42%) were GP-referred; of these, 22 had had a CXR; 6 (4%) were already under respiratory surveillance; and 11 (6%) had previously been seen by secondary care regarding the presenting symptoms. All cases (except 1) were admitted. GP referral varied across DHBs (p=0.04) and ethnic groups (p=0.02). Age, gender, and tumour type were not associated with ED presentation. Lung cancer patients, especially those of Pacific ethnicity, commonly presented as emergencies, often by-passing primary care. This suggests barriers to, or within, primary care and further research is required to explore the reasons underlying these findings.
Despite the importance of New Zealand Cancer Registry (NZCR) data to research and healthcare decision-making, there has been no previous assessment of the accuracy of NZCR data since mandatory reporting commenced in 1994. To assess the completeness and accuracy of NZCR lung cancer data. An audit of secondary care management in Auckland and Northland of lung cancer patients diagnosed in 2004 provided the opportunity to compare data from regional databases (RD) with NZCR data. Of 565 audit cases, 66 cases (12%) were not included on the NZCR listing. The NZCR listing included 9 eligible cases not identified by RD, 1 duplicate registration and 78 (13%) ineligible cases. Few differences occurred in demographic or tumour details for the 490 cases common to both listings. Tumour staging was available for 97% of cases in RD, and disease extent was recorded for 58% in the NZCR. The latter was more likely to be missing for cases with locally advanced disease (p<0.001), older age (p<0.001), or comorbidity (p<0.001). Use of the NZCR alone would have reduced accrual by 12%; disease extent was absent for 42% with a systematic bias towards being unknown for cases with locally advanced disease. Use of NZCR data without recognition of this bias could lead to inappropriate conclusions. Those using NZCR data should be aware of its definitions, methodology and limitations.
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.
The intervention rate (IR) of radiotherapy (RT) is important for health service planning. As actual IRs are commonly lower than those predicted by models, we sought to determine the reasons for this discrepancy, using lung cancer in a mixed urban-rural region of New Zealand (NZ). The appropriate utilisation of RT was calculated as the sum of the actual utilisation 3 years post diagnosis (88% of cases deceased), the estimated utilisation of the 12% remaining alive, and the percentage of cases that may have benefited from RT but did not receive it. The actual utilisation was estimated as 43% (range 40-48%). A further 8% of deceased cases may have benefitted from RT (but were not referred), giving an appropriate utilisation of 51%. An additional 3.5% that may have benefitted from RT declined management. The difference from modelled IRs was due to a combination of early mortality, refusal of treatment and assumed higher RT treatment rates for many clinical scenarios. The appropriate utilisation of RT was substantially lower than IRs derived from models. The assumptions from which these models were derived may result in over-estimates for resource planning purposes.
The New Zealand Pharmaceutical Management Agency (PHARMAC) approved funding of erlotinib in October 2010 as second line therapy in all non-squamous non-small cell lung cancer after platinum-based chemotherapy with no requirement for epidermal growth factor (EGFR) mutation testing. Funding widened in August 2012 to include gefitinib as first line treatment for patients with a proven EGFR mutation. Then in January 2014, both tyrosine kinase inhibitors (TKIs) were approved for first line treatment, but only for disease with EGFR mutation. To report the clinical experience with TKIs in a New Zealand tertiary referral centre over a period of funding change. Retrospective audit of all patients commenced on erlotinib from 1st October 2010 until 1st November 2011, and gefitinib from 1st August 2012 until 31st August 2013. Follow-up was two years for both groups. Each group had 42 patients. Median Progression Free Survival was 76 days in the erlotinib group and 255 days in the gefitinib group. Twenty-eight percent of erlotinib patients had grade 3 adverse events with one treatment related death; fourteen percent of gefitinib patients had grade 3 adverse events. Dose reduction or treatment breaks were required in 12% in each group. Response rate in these audits appear to reflect the change in funding criteria, with improved response rates likely to be associated with more targeted treatment.
Life expectancy in Aotearoa New Zealand has increased over recent decades, but these increases have not been distributed equally across population groups. Examining how changes in cause-specific mortality have contributed to changes in life expectancy can improve understanding of evolving mortality patterns and persistent inequities. This study quantified the contribution of major causes of death to changes in life expectancy over approximately two decades. Mortality data from the New Zealand Mortality Collection and population estimates from Statistics New Zealand were used to calculate life expectancy at birth for Māori, Pacific, Asian, and European and Other populations for the periods 2001-2003 and 2020-2022. Changes in life expectancy were decomposed by age and cause of death using the Arriaga method. Deaths were grouped into major disease categories and selected individual causes to estimate their contribution to the change in life expectancy. Life expectancy increased for all ethnic groups, with the largest absolute increases observed among Māori. Improvements were driven primarily by reductions in mortality at adult and older ages. Across all ethnic and sex groups, declines in cardiovascular disease and cancer mortality accounted for more than half of the total change in life expectancy. Reductions in mortality from diabetes and smoking-related conditions also contributed to increases among Māori and Pacific peoples. Despite these improvements, substantial ethnic inequities in life expectancy remain. Increases in life expectancy in Aotearoa New Zealand between 2001-2003 and 2020-2022 were driven largely by reductions in mortality from major non-communicable diseases, primarily cardiovascular disease and cancer. Māori experienced some narrowing of the life expectancy gap relative to European and Other populations, whereas the gap for Pacific peoples remained largely unchanged. Despite overall improvement, substantial inequities persist. Further increases are likely to depend on strengthening primary prevention, particularly reductions in smoking and cardiovascular risk factors, alongside improved participation in screening and early detection programmes, including the potential role of lung cancer screening, and ensuring equitable access across care pathways.
1. To compare treatment response and survival of patients with small cell lung carcinoma managed at Greenlane Hospital with published results. 2. To compare the outcome of patients with extensive disease treated with oral etoposide with those who received combination chemotherapy. Case notes of all new patients assessed for small cell lung carcinoma between 1993 and 1995 were reviewed. Seventy-eight cases were identified. Sixty-three patients (81%) underwent chemotherapy, of whom 32 had limited disease, 28 extensive disease and three were inadequately staged. Twenty-six patients (81%) with limited disease received combination treatment (carboplatin, etoposide +/- vincristine) compared with 16 (57%) in the extensive disease group. Response rate was significantly higher in those with limited disease (87.5%) than with extensive disease (50%), (p = 0.006). Overall median survival was 56 weeks in the limited disease group and 32 weeks for extensive disease (p = 0.007). Of patients with limited disease who achieved complete or partial response, 41% (n = 9) developed cerebral metastases as the first sign of disease relapse. These patients relapsed late (mean = 56 weeks) compared with those who relapsed at other sites (31 weeks) (p = 0.002). Patients with extensive disease, who received more than one drug (n = 16), had better median survival than those treated with etoposide only (n = 8), 35 vs 12 weeks, respectively (p = 0.6). Severe treatment complications were uncommon in either group. Four patients required admissions for infection although none were neutropenic. Only one patient (12.5%) treated with etoposide and three (18%) with combination chemotherapy developed grade IV neutropenia. 1. The survival in our series was comparable with published data on other treatment regimes. 2. Patients with extensive disease who received etoposide only had poorer median survival compared with those treated with more than one drug. This is likely a result of selection bias and the role of etoposide in palliation needs to be further assessed. 3. In spite of achieving good local control in patients with limited disease, late relapse with cerebral metastases was common. Prophylactic cranial irradiation, particularly in responders, needs to be considered in planning future treatment strategies. Small cell lung carcinoma (SCLC) accounts for 15-20% of all primary lung carcinomas and has an aggressive natural history because of its short tumour-doubling time and early metastatic potential. Chemotherapy has been used as the primary treatment modality for SCLC at Greenlane Hospital since 1979. Carboplatin, etoposide and vincristine (CEV) is an effective combination for patients with limited disease and has been adopted as the standard regime at Greenlane Hospital since 1993. Oral etoposide has attracted attention as a single agent for palliation in patients with advanced small cell lung carcinoma. Aggressive chemotherapy may not be appropriate in these patients whose prognosis is poor in spite of treatment. Etoposide offers the advantage of being an active oral agent and avoids the need for repeated venous access. It has been perceived as less toxic than other regimes and thus a preferred option for frail patients with extensive disease. The aims of this study were to compare treatment response and survival of patients with small cell lung carcinoma treated in our service since the introduction of the CEV regime with published data and to compare the outcome of patients with extensive disease treated with combination chemotherapy with those who receive oral etoposide only.