Managing patients with lung cancer
Authors: M. Costantini
Journal: BMJ (2000)

# Effective communication, palliative care, and guidelines are needed {#article-title-2} EDITOR—We welcome Simmonds's analysis of the management of patients with lung cancer, the “Cinderella of common solid tumours.”1 We believe, however, that he has created two further Cinderellas. The guidelines he cites represent a big advance over previous guidelines because they include a commitment to patient centred care, underpinned by strong evidence supporting communication.2 He does not mention communication, but this is the only route to a clear understanding of what an individual patient would choose. A meta-analysis has concluded that chemotherapy can offer prolonged survival of 1.5-3 months. Such evidence does not, however, inform us of the value of such survival to individual patients. A recent study showed that although 11% of lung cancer patients would not choose a treatment entailing severe toxicity for a possible extra survival of two years, 6% of patients were prepared to do so for a possible survival of only one week.3 This highlights the importance of providing patients with information of all available options in a manner that is not mediated by the physician's assumption of what should be their preference. In the case of advanced lung cancer (as in most advanced disease) this must include the option of palliative care, the second Cinderella of Simmonds's editorial. 1. 1.↵ 1. Simmonds P .Managing patients with lung cancer. New guidelines should improve standards of care. BMJ 1999; 319: 527–528. [OpenUrl][1][FREE Full Text][2] 2. 2.↵ 1. NHS Executive . Guidance on commissioning cancer services. Improving outcomes in lung cancer: the research evidence. Leeds: NHS Executive, 1998. 3. 3.↵ 1. Silvestri G, 2. Prichard R, 3. Gilbert Welch H .Preferences for chemotherapy in patients with advanced non-small cell lung cancer: descriptive study based on scripted interviews. BMJ 1998; 317: 771–775. [OpenUrl][3][Abstract/FREE Full Text][4] # Specialist palliative care is needed {#article-title-5} EDITOR—The role of specialist palliative care was not mentioned in Simmonds's recent editorial on managing patients with lung cancer.1 This is of particular concern as one of the main recommendations of the recently published national guidance on improving outcomes in patients with lung cancer is that palliative care should be an integral part of patient management from … [1]: {openurl}?query=rft.jtitle%253DBMJ%26rft.stitle%253DBMJ%26rft.issn%253D0007-1447%26rft.aulast%253DSimmonds%26rft.auinit1%253DP.%26rft.volume%253D319%26rft.issue%253D7209%26rft.spage%253D527%26rft.epage%253D528%26rft.atitle%253DManaging%2Bpatients%2Bwith%2Blung%2Bcancer%26rft_id%253Dinfo%253Apmid%252F10463876%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/ijlink?linkType=FULL&journalCode=bmj&resid=319/7209/527&atom=%2Fbmj%2F320%2F7231%2F379.atom [3]: {openurl}?query=rft.jtitle%253DBMJ%26rft.stitle%253DBMJ%26rft.issn%253D0007-1447%26rft.aulast%253DSilvestri%26rft.auinit1%253DG.%26rft.volume%253D317%26rft.issue%253D7161%26rft.spage%253D771%26rft.epage%253D775%26rft.atitle%253DPreferences%2Bfor%2Bchemotherapy%2Bin%2Bpatients%2Bwith%2Badvanced%2Bnon-small%2Bcell%2Blung%2Bcancer%253A%2Bdescriptive%2Bstudy%2Bbased%2Bon%2Bscripted%2Binterviews%26rft_id%253Dinfo%253Apmid%252F9740561%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [4]: /lookup/ijlink?linkType=ABST&journalCode=bmj&resid=317/7161/771&atom=%2Fbmj%2F320%2F7231%2F379.atom