There are various policies in the management of non-small cell lung cancer and aspects of the treatment related to quality of life outcome are discussed (Table 4).
Chemotherapy
As Thatcher et al pointed out, non-small cell lung cancer can no longer be regarded as resistant to chemotherapy. Early studies of quality of life in patients receiving chemotherapy suggested that treatment-related toxicity reactions and the deterioration of patient’s well-being offset any potential survival advantage for most patients. In a more systematic assessment of quality of life, change in quality of life scores, as measured by FLI-C, correlated with performance status change and weight loss, but not with treatment regimen, side effects of treatment, or change of pain. Consequent studies pointed out that after chemotherapy, patients had marked relief of symptoms. Recent studies, however, have shown that improved or stable quality of life mainly depends on tumor response. For example, Pujot et al, in a study of 54 patients, found a stable quality of life in responders as compared to those who had not responded to treatment. Another explanation is that baseline quality of life not only predicts the likelihood of response and survival, but also has greater impact than most known prognostic factors (treatment types, performance status, gender, and age). Gralla et al, in a multicenter, randomized trial of a combination chemotherapy regimen, studied 673 patients using the LCSS and found that baseline quality of life was the best predictor of both response to the treatment and survival. Using the same instrument (LCSS), Hollen et al found that physical and functional dimensions were the most important predictors of quality of life in patients receiving chemotherapy. canadian neighbor pharmacy

Chemotherapy and Best Supportive Care
Comparing chemotherapy vs supportive care alone, Buccheri et al studied 74 patients and found that there was no significant difference in depression and performance status between treatment arms. As expected, while a better treatment tolerance was reported in favor of supportive care, a better physical status has been found in favor of the chemotherapy group. In another study, by Ganz et al, due to poor compliance with quality of life assessment, it was impossible to examine differences between treatment arms (supportive care vs supportive care plus chemotherapy). However, they found that there was a positive correlation between quality of life scores as measured by the FLI-C and performance status as measured by the KPS. In a retrospective study in which patients had received chemotherapy or supportive care, it was found that chemotherapy produced a temporary benefit in quality of life as measured by improvement in performance status.
In terms of quality of life, there is no single answer to the question as to whether the best supportive care or chemotherapy could produce a better quality of life, but there is evidence that chemotherapy is less expensive than supportive care. This is because chemotherapy produces tumor control, requires shorter hospital stay, and thus is less expensive.
As Manegold and Schwarz argue, since supportive care is relevant to all patients with non-small cell lung cancer, more education, research, and financial support are needed to optimize quality of life and supportive care of patients.
Table 4—Summary of Selected Quality of Life Studies in Patients With Non-small Cell Lung Cancer

Study (yr) Design Treatment Sample Quality of Life Measure Results/Conclusions
Minet Randomized RT vs RT+CT 81 KPS No significant difference between arms in survival and QL as measured by KPS
Finkelstein et al Descriptive CT 46 FLI-C Change of FLI-C correlated with PS change and weight loss, but not with treatment regimen, side effects of treatment, or change of pain
Kaasa et al Randomized RT vs CT 95 Purposed questionnaire (assessing psychosocial well-being, physical functioning, treatment related symptoms, daily activity, global QL) Significant difference in psychosocial well-being and global QL in favor of RT; no significant group differences in physical functioning and daily activity. Significant difference in treatment-related symptoms in favor of RT
Ganz et al Randomized SC vs SC+CT 48 FLI-C + KPS Positive correlation between FLI-C and KPS; due to poor compliance, studying difference between treatment arms was impossible
Buccheri et al Randomized CT vs SC alone 74 Ad hoc (3 items on treatment tolerance, physical well-being, depression) + KPS No significance difference in depression and PS between treatment arms; better tolerance in favor of SC, but better physical status in favor of CT
Bleehen et al Randomized RT (experimental vs conventional) 365 DDC No survival difference; dysphagia rose during treatment and fell after 2 wk; reduction in physical activity rose during treatment and fell after 5 wk; similar results for mood and overall condition; findings similar in two groups
Bleehen et al” Randomized Palliative RT (2 fractions vs single) 235 Pts: DDC Phyns: overall condition, PS, symptoms No survival difference; no significant differences in most areas that have been assessed, except less dysphagia in favor of single fraction arm
Hopwood and Stephens Randomized RT (shot vs aggressive regimen) 500 RSCL, HADS Survival slightly improved in favor of aggressive regimen, but in other respects (palliation of main symptoms, adverse effects, response, appearance of metastases), the two regimens were very similar
Hollen et al Descriptive CT (a) 207 pts(b) 21 observer LCSS, KPS, SCL-90, POMS Validation study; LCSS pts and observer scales were found to be reliable, valid, and responsive to change
Gralla et al Randomized CT (with vs without edatrexate) 673 LCSS QL at baseline not only predicts for the likelihood of response and for survival, but also has greater impact than most known prognostic factors.