Weighing Toxicity Against Survival Benefit in Counseling

Matthew Gumbleton, MD, PhD, of Huntsman Cancer Institute and Siddhartha Devarakonda, MD, of Providence Swedish Cancer Institute discuss how they translate grade 3 or higher adverse event rates into a conversation a patient can actually use in epidermal growth factor receptor (EGFR)-mutated advanced non–small cell lung cancer (NSCLC). Dr Gumbleton says toxicity grading is hard for patients and clinicians to conceptualize, so his central message is to reach out early rather than wait for a scheduled follow-up. Dr Devarakonda says the first visit for a patient with metastatic disease can take 30 to 40 minutes before toxicity is even raised, and that beyond a point patients stop absorbing information. Rather than reciting every percentage, he gives a few facts, notes that no treatment is free of adverse effects, and tailors the discussion to the patient's work, caregiving demands and sun exposure before offering a recommendation.