In a similar study (standard vs palliative chemotherapy), a significantly better survival was observed in patients receiving standard treatment, despite its greater toxicity. Assessment of quality of life using the EORTC 42-item QLQ demonstrated no significant difference in most areas measured. Less mucositis and alopecia were reported by the patients receiving palliative treatment, while patients in the standard group had better values for sleep disturbance, fatigue, and psychological distress. It is argued that regular chemotherapy, although producing unpleasant side effects, also could be palliative and may control the effects of the progression of cancer. Several studies have shown that different management policies resulted in no major survival benefit. Studying early vs late alternating chemotherapy in a group of 127 patients showed that there was no significant survival difference between treatment groups, but patients receiving early alternating chemotherapy had a better quality of life as measured by the EORTC QLQ questionnaire. Acute Respiratory
However, some studies suggested that the less intensive the treatment, the better the quality of life. The result of a recent randomized trial comparing conventional vs intensive chemotherapy showed a better quality of life in favor of conventional chemotherapy. In a randomized trial of 12 (maintenance) vs six (no maintenance) courses of chemotherapy with addition of radiotherapy in both regimens, it was shown that there were no significant differences in survival. Both assessments of the quality of life as measured by patients using the DDC and as measured by physicians indicated a better quality of life in favor of 6 courses of treatment. However, it was reported that no patients receiving maintenance chemotherapy experienced a gradually deteriorating quality of life as compared to the more severe effects in the maintenance group. Using the same method of measurement, Geddes et al, in a study of eight vs four courses of chemotherapy, reported that there was no significant survival difference between these two regimens. The study results indicated that each successive cycle of chemotherapy had a negative impact on the patient’s quality of life, especially in patients receiving eight courses of chemotherapy. In a series of randomized trials comparing alternating vs response-dependent chemotherapy, carbo- vs cis-platinum, and treatment for extensive vs limited disease, it was noticed that intensive treatment of more than four cycles resulted in an overall marked negative effect on a patient’s quality of life.