Operable Lung Cancer Patients Should Have Chemotherapy Choice

BETHESDA, Md—A leading medical oncologist laments the refusal of many physicians to even discuss the option of adjuvant chemotherapy with patients who have operable lung cancer. Paul Bunn, Jr., MD, director of the University of Colorado Cancer Center, noted that the first drugs used in lung cancer patients, alkylating agents, actually reduced survival time.

“It had an incredibly negative impact on what people wanted to do for operable lung cancer,” he told a conference sponsored by the Alliance for Lung Cancer Advocacy, Support, and Education (ALCASE) and the International Cancer Alliance. And a lasting one, he added. “The introduction of newer drugs has not yet swayed many physicians, especially those who are not oncologists.”

Dr. Bunn described a metaanalysis showing that “postoperative, cisplatin-based chemotherapy increased the absolute cure rate for lung cancer by 5%, with a 13% reduction in the hazard of death, which is similar to what chemotherapy does for breast cancer.”

Many surgeons disparage the study because “there are still not many patients in these trials and the P value is .09,” Dr. Bunn added. Nonetheless, when researchers showed the metaanalysis findings to a group of patients, they found that “95% of patients in the United States will elect to have chemotherapy for a 5% improvement in cure rate” and more than half “will elect chemotherapy for a 1% improvement in cure rate,” he said.

Yet when these patient opinions were shown after publication to physicians in the United Kingdom, 95% said they still would not offer chemotherapy to their patients. “There is no study like that in the United States, but the attitude is clearly very similar,” Dr. Bunn said. “Probably 95% of US physicians will not discuss postoperative chemotherapy with their lung cancer patients.” The decision to undergo chemotherapy should lie with the patient, he said. “I basically show the data to patients and let them choose.”