Treatment approaches for lung cancer patients in a community hospital

During the past decade, a number of new and successful treatments for cancer have been introduced at many cancer centers. During the same period, increasing numbers of cancer patients were treated outside of major cancer centers (i.e., in the community hospital) by an expanding number of trained oncologists. However, it is unclear to what extent new therapeutic approaches have been adopted in the community hospital setting. Recent studies have raised important questions about the patterns of treatment of patients outside of cancer centers. The present study was undertaken to describe the processes of treatment for lung cancer patients in a 514-bed community hospital in a metropolitan area. The study sample consisted of all patients with lung cancer entered into the hospital's tumor registry during 1980 and 1981 (n = 147). Medical oncologists were consulted regarding the care of a large number of patients, particularly those with small cell carcinoma for whom medical oncologists can offer therapy which has been demonstrated to be effective. As judged by patients with small cell carcinoma, patients are being treated appropriately, for the most part, with chemotherapy. Fourteen percent of all patients received no treatment for their cancer, and this may be a source of concern. Future research in this area should be directed at conducting similar studies in smaller hospitals, comparing the quantity and quality of survival for patients treated in various types of settings, and assessing the determinants of processes of care (e.g., no treatment) in various treatment settings.