Chemo May Improve Quality of Life in Advanced Lung Cancer

MONTREAL-Patients with advanced non-small-cell lung cancer (NSCLC)who receive chemotherapy report better symptom control and qualityof life than those who opt for supportive care alone, WilliamK. Evans, MD, chief executive officer, Ottawa Regional CancerCentre, On-tario, said at a symposium on lung cancer organizedby the 19th International Congress of Chemotherapy.

Combination chemotherapy regimens have been shown to produce responserates of between 20% and 30%. Despite occasional dramatic responses,Dr. Evans said that such regimens often are not initiated becausethe physician feels that the potential response does not justifythe associated toxicities.

However, several metaanalyses show that survival is prolongedin those NSCLC patients who receive chemotherapy (Souquet et al:Lancet 342:19-21, 1993; Grilli et al: J Clin Oncol 11:1866-1872,1993).

Although survival prolongation is modest (highly significant differencein survival at 6 months, diminishing by 1 year), other studiesshow that cancer-related symptom improvement is common (65% to70%). Performance status and weight loss can also improve.

Dr. Evans also cited a study showing that, compared with healthypeople, patients with advanced disease are much more willing toaccept aggressive and toxic treatment to achieve even a 1% chanceof cure and a very modest prolongation of life (Slevin et al:Br Med J 300:1458-1460, 1990).

Therapeutic Choices Scrutinized

In Canada, as elsewhere, specific therapeutic choices are beingscrutinized to assess their overall impact on health-care costs,Dr. Evans said. So, although very sick patients may be willingto accept toxic, costly, and only modestly effective treatment,the public may not.

He reported, however, that good supportive care for patients withadvanced NSCLC can be more expensive than chemotherapy if patientsspend more time in the hospital (Jaakkimainen et al: J Clin Oncol8:1301-1309, 1990). The symptom relief provided by chemotherapyin these patients is significant enough, it appears, to reducehospital days.