Accurate mediastinal nodal staging is crucial in the management of non-small cell lung cancer (NSCLC) because it directs therapy and has prognostic value. Now researchers have examined five-year survival after endosonography vs mediastinoscopy for mediastinal nodal staging of lung cancer.

Accurate mediastinal nodal staging is crucial in the management of non-small cell lung cancer (NSCLC) because it directs therapy and has prognostic value. The Assessment of Surgical Staging vs Endosonographic Ultrasound in Lung Cancer (ASTER) trial compared mediastinoscopy (surgical staging) with an endosonographic staging strategy (which combined the use of endobronchial and transesophageal ultrasound followed by mediastinoscopy if negative). The endosonographic strategy was significantly more sensitive for diagnosing mediastinal nodal metastases than surgical staging (94 percent endosonographic strategy vs 79 percent surgical strategy). If mediastinal staging is improved, more patients should receive optimal treatment and might survive longer.
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This analysis evaluated survival in ASTER. Of 241 patients with potentially resectable NSCLC, 123 were randomized to endosonographic staging and 118 to surgical staging in 4 tertiary referral centers. Survival data were obtained through patient records, death registers, or contact with general practitioners. Survival data at 5 years were obtained for 237 of 241 patients. The prevalence of mediastinal nodal metastases was 54 percent in the endosonographic strategy group and 44 percent in the surgical strategy group. Survival at 5 years was 35 percent for the endosonographic strategy vs 35 percent for the surgical strategy. The estimated median survival was 31 months for the endosonographic strategy vs 33 months for the surgical strategy.

Many terminal cancer patients are not getting adequate pain relief early enough, according to an English study. The researchers found that, on average, terminal cancer patients were given their first dose of a strong opioid such as morphine just nine weeks before their death.

Researchers at Leeds University found that, on average, terminal cancer patients were given their first dose of a strong opioid such as morphine just nine weeks before their death. Yet many people with terminal cancer suffer with pain a long time before that, the researchers said.

"We have identified for the first time the relatively late onset and short duration of strong opioid treatment in cancer patients prior to death," said lead study author Dr Lucy Ziegler, a senior research fellow in palliative care at the University of Leeds.
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"This pattern of prescribing does not match population data which points to earlier onset of pain. Nine weeks before death is considered late in the course of the cancer trajectory. Although the prevalence of pain is higher in patients with advanced cancer and towards the end of life, for many patients pain is experienced at many stages throughout the illness. In fact, pain is the most common presenting symptom at diagnosis. Our research highlights the need to prioritise earlier access to effective pain management for patients with advanced cancer."