NEW YORKTodays treatments for lung cancer are much better tolerated than treatments used 20 years ago, Robert Ginsberg, MD, chief of the Thoracic Service, Memorial Sloan-Kettering Cancer Center, said at an NIH video satellite symposium beamed to 20 selected centers nationwide.
Today there is less pain with surgery, patients are back to work faster after surgery, and there is little nausea with chemotherapy, he said at the conference, co-sponsored by four patient advocacy groups, the National Cancer Institute, and others, and supported by a grant from Bristol-Myers Squibb Oncology.
Dr. Ginsberg and other symposium panelists pointed out, however, that few lung cancer patients are aware of how treatment for the disease has evolved or of the availability of clinical trials of promising new therapies, and physicians are often slow to update their practices to include newer regimens or to encourage clinical trial participation.
Clinical Trials Best Treatment
Phase III clinical trials are the best treatment available for lung cancer, said James Jett, MD, co-director of the University of Pittsburghs Lung Cancer Program, but he noted that there are many obstacles to enrollment.
The hurdles include the patients fear of experimentation and a perception that the trial therapy is inferior to currently available treatments; the lack of insurance company payment for participation in trials; and the large commitment of time required of the physician to fully explain trials to patients, Dr. Jett said.
Some of these hurdles can be surmounted, however. The clinical cost for participating in clinical trials is no more than that for standard treatment, said Robert Mass, MD, of the Kaiser Perma-nente Medical Center, San Francisco. If insurance companies understand this, he said, more patients will be able to participate in ongoing trials.
Unfortunately, although the majority of cancer patients ought to be entered into clinical trials, limited resources are a barrier to expanding participation, said Richard Klausner, MD, director of the NCI. He noted that the NCI is only able to support about 2% of all adult cancer patients for clinical trial participation.
Surveys Suggest Gaps in Physician Knowledge of Lung Cancer Treatments
In a study by Dr. Edith Perez, director of clinical trials, the Mayo Clinic, Jacksonville, Fla, 350 randomly selected US physicians from several different specialties were surveyed regarding the treatment of different stages of lung cancer.
The results showed that increased education about current therapies and coordination of multidisciplinary care are necessary to make state-of-the-art treatments available to patients.
Another study suggests that physicians may be reluctant to change their treatment approaches even when they are made aware of improved therapies, said Paul Bunn, MD, director of the University of Colorado Clinical Cancer Center, Denver.
A metaanalysis of 20 years worth of studies of postoperative chemotherapy in lung cancer showed a 5% higher survival rate for the adjuvant therapy than for surgery alone, Dr. Bunn said.
When these data were shown to physicians in the United Kingdom, only 1% said they would offer the treatment to their patients. Conversely, when patients were made aware of this treatment, 95% of them requested the therapy.
Because patients need to have some control over their destiny, they may be less inclined to accept randomization, Dr. Ginsberg said. But Diane Blum, MSW, executive director of Cancer Care, Inc. pointed out that education about how clinical trials are structured and promotion of ongoing clinical trials to both physicians and patients can help alleviate patients fears and misunderstanding.
The need to enter lung cancer patients into trials highlights the importance of good patient/physician communication in this disease. Dr. Ginsberg said that patients must be more inquisitive regarding their treatment options, a behavior that requires effort and education.
Educating Primary Care Physicians
From the physicians side, Dr. Jett stressed the importance of educating the primary care physician about the most up-to-date therapies
For patients, taking control is todays message, said Ellen Stovall, executive director of the National Coalition for Cancer Survivorship, one of the organizations sponsoring the forum. Open communication; education about trials, treatments, and support groups; and active involvement in ones treatment all serve to enhance the quality of life for lung cancer patients.