In individuals with sophisticated non-small cell lung cancer: descriptive study primarily based on scripted interviews. BMJ 1998:317:771-5.tions within the severity of numerous of the symptoms, including discomfort, seasoned by individuals with lung cancer.4 Studies from France show that pain management in cancer centres is often suboptimal.Teresa Beynon consultant in palliative medicine Victoria Lidstone registrar in palliative medicine Claire Sinnott consultant in palliative medicine Michael Richards Sainsbury professor of palliative medicine Department of Palliative Medicine, St Thomas’s Hospital, London SE1 7EH1 Simmonds P. Managing sufferers with lung cancer. New suggestions should boost requirements of care. BMJ 1999;319:527-8. (28 August.) two NHS Executive. Guidance on commissioning cancer services. Improving outcomes in lung cancer: the research proof. Leeds: NHS Executive, 1998. 3 Degner LF, Sloan JA. Symptom distress in newly diagnosed cancer patients and as a predictor of survival in cancer. J Discomfort Symptom Handle 1995;10:423-31. four Beynon T. Palliative care assessment tool. Palliat Med 1997;11:57-8. 5 Larue F, Colleau SM, Brasseur L, Cleeland CS. Multicentre study of cancer pain and its treatment in France. BMJ 1995;301:1034-7.Biomedical literature does not assistance routine use of laboratory variables as prognostic factors Editor–Simmonds in his editorial on managing patients with lung cancer states that, also for the extent in the illness plus the overall performance status, various laboratory variables (for instance, serum concentrations of sodium and activity of alkaline phosphatase, aspartate aminotransferase, and lactate dehydrogenase) is often used to guide the therapy of patients with small cell lung cancer.1 We’ve got lately reviewed the biomedical literature generated in this field more than the past 20 years,two three employing the solutions suggested by the International Federation of Clinical Chemistry.4 Within the table we’ve got summarised the outcomes from the 52 research which have evaluated the pretherapeutic prognostic significance (with regards to survival) of serum concentrations of sodium and activities of alkaline phosphatase, aspartate aminotransferase, and lactate dehydrogenase in individuals with modest cell lung cancer. The column labelled “uncertain significance” corresponds to variables that have been found important by authors who had omitted at the very least Title Loaded From File certainly one of the following radioclinical variables from their multivariate statistical analysis: weight reduction, age, gender, overall performance status, and extension from the disease. The situation summarised inside the table did not change when we tried to determine the laboratory variables that may well have an independent prognostic significance in subgroups of patients with smallSpecialist palliative care is necessary Editor–The role of specialist palliative care was not described in Simmonds’s current editorial on managing individuals with lung cancer.1 This really is of distinct concern as certainly one of the primary suggestions with the lately published national guidance on improving outcomes in patients with lung cancer is the fact that palliative care needs to be an integral aspect of patient management from the outset and that this needs to be the responsibility of a multiprofessional team that has close links with all the lung cancer team.2 Patients with lung cancer typically possess a very poor prognosis, several physical symptoms, and psychosocial issues.3 Within a recent study of 480 patients attending oncology clinics at Guy’s and St Thomas’s Hospitals, London, these with lu.