Palliation and life quality in lung cancer; how good are clinicians at judging treatment outcome?

Abstract

Summary A recent trial by the MRC Lung Cancer Working Party used physician assessments to compare two palliative schedules of radiotherapy in lung cancer. A prospective study has been undertaken on a subset of these trial patients to see how physician assessments of symptomatic relief and general condition correlate with patient perception of therapeutic response. In 40 patients followed up monthly from presentation until close to death, good agreement was found between doctors and patients on change in specific physical symptoms and overall physical condition. Doctors were poor judges of life quality at presentation but appeared able to identify relative improvement or deterioration in overall quality of life. In conclusion, physician assessments may constitute valid end-points for radiotherapy trials comparing palliative schedules in lung cancer.

No pain relief from morphine?

“…it would be unethical to rechallenge a patient with morphine after a satisfactory outcome on an alternative opioid.) Other studies have shown some reliability in how good clinicians are at judging treatment outcomes [17]. Our study shows that 87% (41/47) morphine non-responders did improve when switched to an alternative opioid suggesting that side effects were morphine related although we accept that we could not control for all other variables.…”

Quality of life measures (EORTC QLQ-C30 and SF-36) as predictors of survival in palliative colorectal and lung cancer patients

“…It seems plausible that patients' ratings of their general health and QoL should contribute more to prediction alongside clinical variables than self-rated symptoms or functional status, as the latter to some extent can be assessed by others, although not perfectly. Although clinicians are reasonably able to assess observable symptoms, they are poor at assessing patients' QoL (Fowlie et al, 1989; Regan et al, 1991). However, if HRQoL measures make their greatest contributions to prediction of survival by measuring global health/QoL, a more comprehensive generic measure may add more predictive value than cancer-specific measures that include symptoms, particularly in situations where clinical information is already fairly comprehensive.…”

Evaluation of Clinical Benefit of Chemotherapy in Patients with Upper Gastrointestinal Cancer

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