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, 1993).
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 hospital days.