Non-small Cell Lung Cancer
Disease Staging/Prognosis
Factors that affect prognosis
As previously discussed, there is an association between disease stage and prognosis. A range of other factors are important in determining prognosis and hence suitability of therapy. Factors that can be considered include the age of the patient as well as his or her general health, performance status (PS) and QoL, with particular regard to disease-related symptoms and the intensity of these symptoms. Historically, the elderly and those with a poor PS have not generally been considered suitable for intensive cytotoxic chemotherapy and therefore have lower survival rates compared with younger, healthier patients.1,2
QoL is a key issue for patients with advanced or late-stage NSCLC. Patients and their carers often have to make difficult choices to balance the advantages of aggressive or intensive chemotherapy, in terms of life extension or tumour control, versus the considerable side effects, which may include acute conditions such as diarrhoea and vomiting, neutropenia accompanied by the risk of increased infections, alopecia (hair loss), and less direct effects such as extended hospitalisation and tiredness. However, non-treatment and the ensuing progression are also associated with a decrease in QoL due to, amongst other things, pain, discomfort, and psychological effects like depression.
One of the aims of the new targeted therapies is to reduce treatment-related toxicity, so that more patients can achieve an improvement in their prognosis whilst maintaining or even improving QoL.
References:1. Govidian R. Management of patients with non-small-cell lung cancer and poor performance status. Curr Treat Options Oncol 2003;4:55–9.
2. Lilenbaum R. Management of advanced non-small-cell lung cancer in elderly
populations. Clin Lung Cancer 2003; 5:169–73.
