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Palliative benefits of chemotherapy underappreciated

In the February issue of Supportive Oncology, Dr. David H. Johnson, director of the Division of Hematology and Oncology at the Vanderbilt-Ingram Cancer Center in Nashville, summarized various presentations from the 2005 supportive oncology conference held in Chicago.

According to Johnson, the palliative benefits of chemotherapy for advanced non-small cell lung cancer, in terms of prolonging life and controling common symptoms such as cough, pain, shortness of breath and malaise, were well documented by clinical trials as early as 1995.

One pivotal study noted the magnitude of the above symptoms' control with chemotherapy ranged from 40 to 75 percent. Other studies validate the benefits of chemotherapy and show the significant benefits of symptom control and improvement in quality of life.

Another survey showed that nearly 40 percent of primary care physicians and surgeons were unaware of the palliative benefits of chemotherapy, even though 60 percent of their peers were recommending palliative chemotherapy for advanced non-small cell lung cancer.

A survey of 1,200 lung physicians and surgeons revealed that only 33 percent believed that chemotherapy prolongs survival in lung cancer, and that only 60 to 70 percent were aware of the palliative benefits of chemotherapy.

A pivotal paper in 1990 found that patients would accept "mild" chemotherapy for a 1 percent chance of symptom improvement, "intense" chemotherapy for a 10 percent chance, and any form of chemotherapy for 1 percent probability of a cure.

Since then, the ease of administration and tolerance of chemotherapy have improved several fold. For instance, in 1983, when I started my practice in Citrus County, virtually all chemotherapy was done in the hospital. In the past 15 years we have performed office-based chemotherapy for virtually all patients, even for those in the ninth decade of life.

Why, then, is there this disconnect between patient acceptance and physician recommendations?

One possible explanation is that the rapid progress in technology makes it difficult for physicians to keep abreast of advances in their own fields, let alone those in other specialties. This is particularly true for primary care physicians who deal with many diseases and are put in the difficult position of making the right choice every time.

The other explanation is that oncologists have failed to educate their colleagues as to the benefits of palliative chemotherapy for advanced non-small cell lung cancer.

Regardless of the reason, only those patients who are referred or seek direct consultation will realize the benefit of what modern cancer treatment has to offer. How can we reach the rest?

V. Upender Rao, MD, FACP, practices at the Cancer and Blood Disease Center in Lecanto.