MONTREAL-Patients with advanced non-small-cell lung cancer (NSCLC)
who receive chemotherapy report better symptom control and quality
of life than those who opt for supportive care alone, William
K. Evans, MD, chief executive officer, Ottawa Regional Cancer
Centre, On-tario, said at a symposium on lung cancer organized
by the 19th International Congress of Chemotherapy.
Combination chemotherapy regimens have been shown to produce response
rates of between 20% and 30%. Despite occasional dramatic responses,
Dr. Evans said that such regimens often are not initiated because
the physician feels that the potential response does not justify
the associated toxicities.
However, several metaanalyses show that survival is prolonged
in those NSCLC patients who receive chemotherapy (Souquet et al:
Lancet 342:19-21, 1993; Grilli et al: J Clin Oncol 11:1866-1872,
Although survival prolongation is modest (highly significant difference
in survival at 6 months, diminishing by 1 year), other studies
show that cancer-related symptom improvement is common (65% to
70%). Performance status and weight loss can also improve.
Dr. Evans also cited a study showing that, compared with healthy
people, patients with advanced disease are much more willing to
accept aggressive and toxic treatment to achieve even a 1% chance
of 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 being
scrutinized to assess their overall impact on health-care costs,
Dr. Evans said. So, although very sick patients may be willing
to accept toxic, costly, and only modestly effective treatment,
the public may not.
He reported, however, that good supportive care for patients with
advanced NSCLC can be more expensive than chemotherapy if patients
spend more time in the hospital (Jaakkimainen et al: J Clin Oncol
8:1301-1309, 1990). The symptom relief provided by chemotherapy
in these patients is significant enough, it appears, to reduce