BMC Cancer 2009, 9:130 http://www.biomedcentral.com/1471-2407/9/130 the chemotherapy arm compared with 4.8 months in the BSC arm (p = 0.03)[2]. Quality of life improved from baseline to six weeks in the chemotherapy arm and dete- riorated in the BSC arm (p = 0.007)[2]. A systematic review by Clegg found that the chemotherapeutic agents paclitaxel, docetaxel, gemicitabine and virorelbine improved survival in advanced NSCLC by 2–4 months compared to BSC, without compromising quality of life and that it was cost effective. [3] Although the large chemotherapy versus BSC trials, and the more recent combination chemotherapy trials, reported a significant benefit from chemotherapy in both survival and quality of life in advanced NSCLC, all were performed in relatively young, highly selected groups of patients. Some of the more influential recent studies performed for patients with NSCLC have included (i) European Co- operative Oncology Group (ECOG) E1594[4], (ii) South Western Oncology Group SWOG 9509[5] and (iii) TAX 326[6]. The ECOG 1594 trial compared paclitaxel and cis- platin with the following regimens: gemcitabine and cis- platin; docetaxel and cisplatin; or paclitaxel and carboplatin in 1155 patients. There was no difference in response rate (19%), median survival (7.9 months) or 1- year survival (33%) between the four arms. Time to pro- gression was significantly better in the gemcitabine/cispl- atin arm but there was greater renal toxicity. Initially patients with ECOG PS 2 were eligible, but the criteria were changed to exclude them after it became evident that patients with PS 2 had a significantly higher rate of adverse events than PS 0–1. Median survival in patients with PS 0 was 10.8 months, PS 1 7.1 months and in PS 2 3.9 months (p < 0.001)[4]. SWOG 9509 enrolled 406 patients with advanced NSCLC, all with ECOG performance status 0–1. Patients were ran- domised to receive either vinorelbine and cisplatin, or paclitaxel and carboplatin. There was no difference in median survival, 1 or 2 year survival or quality of life[5]. TAX326 randomised 1218 patients to receive either docetaxel and cisplatin, docetaxel and carboplatin or vinorelbine and cisplatin. Patients receiving docetaxel and cisplatin had a median survival of 11.3 months compared to 10.1 months for vinorelbine/cisplatin (p = 0.044), with no significant difference in median survival between vinorelbine/cisplatin and docetaxel/carboplatin, but poorer quality of life in the vinorelbine arm [6]. The highly selected patients treated in these clinical trials raises doubts about the applicability of their results to other patients with lung cancer. We therefore designed a questionnaire to determine how many of the total pool of patients with advanced NSCLC presenting to the Sydney Cancer Centre (excluding the Palliative Care department) would have been eligible for these recent randomised tri- als of chemotherapy and to document the reasons for ineligibility. Methods Patients were recruited from the Royal Prince Alfred Hos- pital and Concord Repatriation General Hospital, Sydney, Australia from October 2001 until December 2002. Ethics committee approval was obtained from both participat- ing hospitals. All physicians from Medical Oncology, Radiation Oncology, Respiratory Medicine and Thoracic Surgery were requested to complete a questionnaire at the time of the initial consultation for each new patient with Stage IIIB (pleural effusion) and Stage IV NSCLC present- ing to their service. Basic demographic information was collected and histological subtype and staging was recorded as well as the presence (or not) of measurable or evaluable disease. Information on co-morbidities, prior history of malignancy and laboratory tests, including full blood count, liver function tests and creatinine, were recorded. Any previous treatment for lung cancer was doc- umented and Eastern Co-operative Oncology Group (ECOG) performance status (PS) was evaluated. Physi- cians were asked to estimate patient's life expectancy as less than or greater than 12 weeks, to document weight loss of greater than 10% in the past 6 weeks, and to assess whether the patient was capable of giving informed con- sent. Patients seen by more than one service were only counted once. All patients referred to the Sydney Cancer Centre are reg- istered in a data base. This cancer registry was reviewed to determine how many patients with advanced NSCLC had been referred to the service during this period. A retrospec- tive review of the medical records of patients not evalu- ated prospectively was undertaken to obtain as much information as possible: the hospital and oncology medi- cal records were reviewed, the individual specialist was contacted and the hospital electronic pathology, labora- tory and imaging results were examined. Each patient's data were then reviewed to determine whether or not they met the eligibility criteria for each of the following trials: (i) ECOG E1594, (ii) SWOG 9509 and (iii) TAX 326. Statistical methods Descriptive methods were used to summarise demo- graphic characteristics. Analysis involved simple summary statistics, performed on Excel. Analysis of the prospective and retrospective data are presented separately as well as combined. Where information was unobtainable retro- spectively (e.g. life expectancy) a conservative estimate was assumed. Where no evidence could be found that a patient had attended any appointment or had any investi- Page 2 of 6 (page number not for citation purposes)