Test Your Knowledge: Ten Questions about Lung Cancer

Take our online quiz to see how much you know about the epidemiology, treatment, and prognosis of lung cancer.

RTCs have shown that screening with spiral computed tomography (CT) reduces lung cancer mortality Screening with frequent chest X rays is associated with reduced lung cancer mortality compared with less frequent screening Screening with frequent chest X rays is associated with increased lung cancer mortality compared with less frequent screening Question 7. Which of the following best refl ects the evidence on the value of giving palliative chemotherapy to patients with stage 4 non-small cell lung cancer (the most advanced stage)?
Palliative chemotherapy improves survival at one year and is associated with improved quality of life Although palliative chemotherapy improves survival at one year, its side effects mean that the treatment is associated with impaired quality of life Palliative chemotherapy is associated with improved quality of life, but there is no evidence that it prolongs survival Test Your Knowledge: Ten Questions about Lung Cancer Question 8. In people with resectable non-small cell lung cancer, which of the following best refl ects the evidence on the value of adjuvant chemotherapy?
There is no evidence that giving adjuvant chemotherapy prolongs survival compared with surgery alone Several systematic reviews and several RCTs have shown conclusively that adjuvant chemotherapy prolongs survival compared with surgery alone Although the overall evidence is inconclusive, two recent RCTs suggest that adjuvant chemotherapy may confer a survival benefi t in resectable stage 1B to stage 3 disease Question 9. In people who are in complete remission from small cell lung cancer, which of the following best refl ects the evidence on giving prophylactic cranial irradiation?

It confers a large survival benefi t
It confers a small survival benefi t It confers no survival benefi t Question 10. Which of the following best refl ects the evidence on giving oral etoposide compared with giving combination chemotherapy to people with extensive-stage small cell lung cancer?
There is no survival difference between etoposide and combination chemotherapy Etoposide is associated with increased survival compared with combination chemotherapy Etoposide is associated with reduced survival compared with combination chemotherapy

Answer 1. About 20%-25%
Small cell lung cancer constitutes about 20%-25% of all lung cancers. The rest are non-small cell lung cancers, of which adenocarcinoma is now the most prevalent form [1,2].

Answer 2. First
Lung cancer is the leading cause of cancer death worldwide in both men and women [1]. There are 1.2 million new cases diagnosed each year [2]. Answer 4. None of the above A Cochrane systematic review examined four randomized controlled trials (RCTs) that compared different supplements against each other, or supplements versus placebo, which involved a total of 109,394 participants. The review found no evidence to support recommending vitamins such as alpha-tocopherol, beta-carotene, or retinol, alone or in combination, to prevent lung cancer [1]. The review found a harmful effect (a statistically signifi cant increased risk of lung cancer incidence and mortality) for beta-carotene with retinol at pharmacological doses in people with risk factors for lung cancer (smoking and/or occupational exposure to asbestos).

Answer 6. Screening with frequent chest X rays is associated with increased lung cancer mortality compared with less frequent screening
A Cochrane systematic review searched for all controlled trials of screening for lung cancer using sputum examinations, chest radiography, or chest CT [1]. Seven trials were included (six randomized controlled studies and one nonrandomized controlled trial) with a total of 245,610 participants. Frequent screening with chest X rays was associated with an 11% relative increase in mortality from lung cancer compared with less frequent screening (relative risk = 1.11; confi dence interval, 1.00-1.23). The reviewers found no controlled studies of spiral CT. The National Lung Screening Trial (http:⁄⁄www.nci.nih.gov/nlst)-a very large randomized study of 50,000 participants-is underway in the United States to compare mortality between spiral CT and chest X rays.

Answer 7. Palliative chemotherapy improves survival at one year and is associated with improved quality of life
Systematic reviews in people with stage 4 non-small cell lung cancer have found that adding chemotherapy regimens that contain cisplatin to best supportive care increases survival at one year compared with supportive care alone [1]. In one review, for example, median survival was 5.5 months with cisplatin-containing regimens plus supportive care versus four months with supportive care alone [2]. There is also some evidence from RCTs that adding chemotherapy to best supportive care may improve quality of life compared with best supportive care alone [1]. Answer 8. Although the overall evidence is inconclusive, two recent RCTs suggest that adjuvant chemotherapy may confer a survival benefi t in resectable stage 1B to stage 3 disease While published systematic reviews and RCTs have failed to clearly show a survival benefi t [1,2,3,4,5,6], two newer RCTs that have been presented as abstracts at meetings suggest that adjuvant chemotherapy (third-generation agents plus a platinum drug) may confer a survival benefi t for resectable stage 1B-3 disease compared with surgery alone [7,8].
Answer 9. It confers a small survival benefi t A Cochrane systematic review identifi ed seven RCTs, involving 987 patients with small cell lung cancer in complete remission, comparing cranial irradiation with no cranial irradiation [1]. Cranial irradiation conferred a small survival benefi t (relative risk of death at three years was 0.84 [95%; confi dence interval, 0.73 to 0.97], corresponding to a 5.4% increase in survival). The fact that the survival benefi t is small refl ects the impact of other events not infl uenced by prophylactic cranial irradiation, such as metastases outside the brain or thoracic relapse [2,3].
Answer 10. Etoposide is associated with reduced survival compared with combination chemotherapy Two RCTs in people with extensive-stage small cell lung cancer found that oral etoposide reduced survival compared with combination chemotherapy at one year [1,2].