In the third-line setting , for patients who have not received erlotinib or gefitinib , treatment with erlotinib is recommended .
There are insufficient data to recommend routine third-line cytotoxic therapy .
Purpose To provide evidence -based recommendations to up date the American Society of Clinical Oncology guideline on systemic therapy for stage IV non – small-cell lung cancer ( NSCLC ) .
Results This guideline up date reflects changes in evidence since the previous guideline .
Increased satisfaction with care and lower costs: results of a randomized trial of in-home palliative care.
OBJECTIVES To determine whether an in-home palliative care intervention for terminally ill patients can improve patient satisfaction , reduce medical care costs , and increase the proportion of patients dying at home .  DESIGN A r and omized , controlled trial . SETTING Two health maintenance organizations in two states . PARTICIPANTS Homebound , terminally ill patients ( N=298 ) with a prognosis of approximately 1 year or less to live plus one or more hospital or emergency department visits in the previous 12 months . INTERVENTION Usual versus in-home palliative care plus usual care delivered by an interdisciplinary team providing pain and symptom relief , patient and family education and training , and an array of medical and social support services . MEASUREMENTS Measured outcomes were satisfaction with care , use of medical services , site of death , and costs of care . RESULTS Patients r and omized to in-home palliative care  reported greater improvement in satisfaction with care at 30 and 90 days after enrollment ( P<.05 ) and were more likely to die at home than those receiving usual care ( P<.001 ) . In addition , in-home palliative care subjects were less likely to visit the emergency department ( P=.01 ) or be admitted to the hospital than those receiving usual care ( P<.001 ) , result ing in significantly lower costs of care for intervention patients ( P=.03 ) . CONCLUSION In-home palliative care significantly increased patient satisfaction while reducing use of medical services and costs of medical care at the end of life . This study , although modest in scope , presents strong evidence for reforming end-of-life care
In the third-line setting , for patients who have not received erlotinib or gefitinib , treatment with erlotinib is recommended .
There are insufficient data to recommend routine third-line cytotoxic therapy .
Purpose To provide evidence -based recommendations to up date the American Society of Clinical Oncology guideline on systemic therapy for stage IV non – small-cell lung cancer ( NSCLC ) .
Results This guideline up date reflects changes in evidence since the previous guideline .