Letters

Managing patients with lung cancer

BMJ 2000; 320 doi: https://doi.org/10.1136/bmj.320.7231.379 (Published 05 February 2000) Cite this as: BMJ 2000;320:379

Effective communication, palliative care, and guidelines are needed

  1. Massimo Costantini, consultant in clinical epidemiology (costantini@ermes.cba.unige.it),
  2. Irene J Higginson, professor of palliative care and policy,
  3. Calliope C S Farsides, senior lecturer in medical ethics,
  4. Franco Toscani, director,
  5. Susie Wilkinson, senior lecturer in palliative care
  1. Servizio di Epidemiologia Clinica e Sperimentazioni Controllate, Istituto Nazionale per la Ricerca sul Cancro, I-16132 Genoa, Italy
  2. Department of Palliative Care and Policy, King's College London and St Christopher's Hospice, London SE26 6DZ
  3. Centre of Medical Law and Ethics, King's College, London WC2R 2LS
  4. Istituto di Ricerca in Medicina Palliativa “L Maestroni,” I-26100 Cremona, Italy
  5. Marie Curie Palliative Care Research and Development Unit, Department of Oncology, Royal Free and University College Medical School, Royal Free Campus, London NW3 2PF
  6. Department of Palliative Medicine, St Thomas's Hospital, London SE1 7EH
  7. Laboratoire de biologie polyvalente, Centre Hospitalier Général, F-12027 Rodez Cédex 9, France
  8. National Institute for Cancer Research, I-16132 Genoa, Italy
  9. University of Udine, I-33100 Udine, Italy
  10. Pulmonary Medicine, Forlanini Hospital, I-00149 Rome, Italy
  11. Santa Chiara Hospital, I-56100 Pisa, Italy
  12. Italian Lung Cancer Task Force (FONICAP), National Institute for Cancer Research, I-16132 Genoa, Italy
  13. Cancer Research Campaign, Wessex Medical Oncology Unit, Southampton General Hospital, Southampton SO16 6YD

    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.

    References

    1. 1.
    2. 2.
    3. 3.

    Specialist palliative care is needed

    1. Teresa Beynon, consultant in palliative medicine,
    2. Victoria Lidstone, registrar in palliative medicine,
    3. Claire Sinnott, consultant in palliative medicine,
    4. Michael Richards, Sainsbury professor of palliative medicine
    1. Servizio di Epidemiologia Clinica e Sperimentazioni Controllate, Istituto Nazionale per la Ricerca sul Cancro, I-16132 Genoa, Italy
    2. Department of Palliative Care and Policy, King's College London and St Christopher's Hospice, London SE26 6DZ
    3. Centre of Medical Law and Ethics, King's College, London WC2R 2LS
    4. Istituto di Ricerca in Medicina Palliativa “L Maestroni,” I-26100 Cremona, Italy
    5. Marie Curie Palliative Care Research and Development Unit, Department of Oncology, Royal Free and University College Medical School, Royal Free Campus, London NW3 2PF
    6. Department of Palliative Medicine, St Thomas's Hospital, London SE1 7EH
    7. Laboratoire de biologie polyvalente, Centre Hospitalier Général, F-12027 Rodez Cédex 9, France
    8. National Institute for Cancer Research, I-16132 Genoa, Italy
    9. University of Udine, I-33100 Udine, Italy
    10. Pulmonary Medicine, Forlanini Hospital, I-00149 Rome, Italy
    11. Santa Chiara Hospital, I-56100 Pisa, Italy
    12. Italian Lung Cancer Task Force (FONICAP), National Institute for Cancer Research, I-16132 Genoa, Italy
    13. Cancer Research Campaign, Wessex Medical Oncology Unit, Southampton General Hospital, Southampton SO16 6YD

      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 …

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