Survey on the treatment of non-small cell lung cancer (NSCLC) in England and Wales

Abstract

Six hundred and ninety eight (85%) of the 821 clinicians responded. For Case 1, 74% would not recommend any adjuvant treatment, 24% would recommend radiotherapy, and <1% chemotherapy, and there was little expectation that adjuvant treatment would improve survival. For Case 2, 68% would recommend radiotherapy, 11% chemotherapy, and 1% surgery, 7% recommending a combination. Adjuvant treatment, regardless of modality, was expected to improve survival. For Case 3, only 11% would recommend chemotherapy, but 26% if the patient was aged ≤50 yrs. There was little expectation of survival beyond 1 yr, or of improving survival with chemotherapy. For all three cases, most of those not recommending chemotherapy would require it to achieve substantially improved survival for them to use it routinely.Surgery alone is currently considered sufficient for resectable non-small cell lung cancer. Chemotherapy is rarely recommended for disease of any stage.

Estimating a treatment effect in survival studies in which patients switch treatment

“…This trial was designed to investigate and compare immediate versus delayed thoracic radiotherapy in patients with inoperable NSCLC, as there exists some doubt as to the clinical beneÿt of immediate radiotherapy for those patients with NSCLC (Carroll et al [10], Crook et al [11]). Articles by Phillips and Miller [12] and Cox et al [13] advocate immediate thoracic radiotherapy, suggesting that one may achieve a prolonged survival and may also improve a patient's quality of life.…”

Targeted therapies in the treatment of advanced non-small cell lung cancer elderly patients

“…Physician skepticism regarding the benefits of chemotherapy for NSCLC has been reported by Raby et al, who found that only 20% of Canadian physicians surveyed thought that treating advanced NSCLC with chemotherapy was worthwhile [9], and by Crook et al in Great Britain, who reported that 11% of clinicians would recommend chemotherapy for appropriate patients, with that proportion rising to 26% if the patient was less than 50 years old [10].…”

The consistency of panelists’ appropriateness ratings: do experts produce clinically logical scores for rectal cancer treatment?

“…It is well recognized that many cancer treatments are not provided in accordance with the best available clinical evidence [1][2][3][4][5][6][7]. This problem has been addressed in part by the development of clinical practice guidelines (CPGs), that have been used not only to assist clinical decision making, but have also been used as a benchmark to evaluate the treatment provided in the community [5,6,8].…”