Quality-of-Life Considerations in Patients with Advanced Lung Cancer: Effect of Topotecan on Symptom Palliation and Quality of Life

Abstract

Key goals in the treatment of lung cancer are to improve both survival and quality of life (QOL). While formal techniques are frequently used to evaluate survival and response, such rigor is used less often in assessing the impact of treatment on quality of life. Many patients with lung cancer are elderly and have complex medical histories and a myriad of comorbidities. In these patients, with limited survival expectations, symptom palliation, quality of life, and convenience of therapy are especially important end points. Indeed, clinical trials are now incorporating symptom scores and QOL outcomes in their designs (now combined as "patient reported outcomes" or PROs). Moreover, symptom palliation correlates well with QOL and survival duration, providing further rationale for therapy selection based on these parameters. The potential palliative and QOL benefits of chemotherapy have been investigated for several agents in lung cancer trials. The Oncologist 2004;9(suppl 6):14-24 www.TheOncologist.com Correspondence: Richard J. Gralla, M.D., New York Lung Cancer Alliance, 459 Columbus Avenue (PMB-187), New York, New York 10024-5129, USA. Telephone: 212-579-6084; Fax: 801-365-6442; e-mail: rgralla@att.net Received October 4, 2004; accepted for publication October 9, 2004. ©AlphaMed Press 1083-7159/2004 The Oncologist ® LEARNING OBJECTIVESAfter completing this course, the reader will be able to:1. Explain the rationale for evaluating quality of life as a treatment end point.2. Describe the multidisciplinary dimensions incorporated into validated quality-of-life questionnaires.

Topotecan in the Treatment of Recurrent Small Cell Lung Cancer: An Update

“…The recently reported preliminary results from phase III testing of oral versus i.v. topotecan were consistent with the results of the phase II trials of oral topotecan in patients with relapsed SCLC [19,36]. The apparently superior hematologic toxicity profile suggests that oral topotecan may be a favorable therapeutic modality for patients with poor PS scores and may offer greater ease of use and convenience to patients [26].…”

“…Oral topotecan has a 30%-40% bioavailability and no known food or drug interactions [33][34][35]. (For more details, see Gralla [36].) In addition, oral topotecan has a lower peak blood concentration than i.v.…”

Quality of life in lung cancer patients due to treatment

“…Some complaints/symptoms during the administration of chemotherapy are actually side effects of chemotherapy and some are the result of the underlying disease; while in some cases they overlap. (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) Radiotherapy works differently on certain aspects of quality of life as well as the individual symptoms. In this study, radiation therapy reduced pain and coughing; and it was observed that hair loss was less pronounced in this group of patients.…”

Treatment options for small cell lung cancer – do we have more choice?

“…It is estimated that 80% of patients with LD, and almost all patients with ED, relapse or experience disease progression (Clark and Ihde, 1998). As the prognosis is poor, symptom palliation and maintenance of QoL are important therapeutic goals in the relapsed setting (Gralla, 2004;Nicum and O'Brien, 2007).…”