This is from the Moss Reports, you might want to google them

CHEMOTHERAPY FOR LUNG CANCER IN OLDER PATIENTS – INEFFECTIVE AND COSTLY

In another blow to the use of chemotherapy in the treatment of lung cancer, researchers at the National Bureau of Economic Research have found that chemotherapy for non-small cell lung cancer (NSCLC) in people 65 and older has a minimal impact on survival.

Rebecca M. Woodward, PhD, a former research associate at Harvard University, used US government data to calculate the life expectancy of patients after they received a diagnosis of lung cancer. She and her colleagues combined survival data with information from the government’s Continuous Medicare History Sample File to calculate lifetime treatment costs.

Over the 15 year period between 1983 and 1997, the life expectancy for older NSCLC patients improved by an average of 0.6 months, or just 18 days. But the cost of treating such patients skyrocketed by $20,157 per patient. Medical economists judge the cost-effectiveness of a treatment by the standard yardstick of how much money it would take to increase survival by one year. The cost of treating lung cancer in this patient population comes to $403,142 per life-year. The more advanced the cancer, the more expensive each day or week of increased survival. Specifically, it costs $143,614 per life-year for localized lung cancer, $145,861 for regional lung cancer and a whopping $1,190,322 for metastatic NSCLC. Almost all the 18 days of extra survival achieved between 1983 and 1997 occurred in patients with localized cancer.

Cigarette smoking is of course the major cause of non-small cell lung cancer. Smoking cessation programs have an average price tag (in 1995 dollars) of $2,587 per life-year saved. Thus, preventing lung cancer is more than 100 times more cost effective than treating it! (Cromwell 1997)

Rebecca Woodward and her colleagues believe that the treatment of lung cancer should be reevaluated. “Given the number of patients affected and dollar values involved, a clear analysis and frank discussion of what has transpired in the big picture of cancer care is necessary to establish the background for our medical, political and economic discussions. Our results indicate that marked improvement has not occurred to date in the case of spending on non-small cell lung cancer treatment for those aged 65 and older,” Dr. Woodward said.

The researchers also said caution should be used before encouraging more intensive care for patients with lung cancer without considering the impact that such interventions might have in terms of the cost, and the potentially deleterious effect of treatment on patients’ quality of life.

Not everyone is ready for a frank discussion of chemotherapy’s failures, however. Some authors have commented that recent advances in treating lung cancer – particularly two FDA approved drugs, Iressa and Tarceva – have radically altered this picture by making the treatment of NSCLC more effective.

“Treatment and supportive care have dramatically improved, as witnessed by arriving at second- and third-line treatments,” Joseph Aisner, MD, chief medical officer at the Cancer Institute of New Jersey told the online journal, Hem/Onc Today (Brinson 2007).

But have these drugs really brought about a “dramatic improvement” in the treatment of lung cancer? In one clinical trial, the median survival in Tarceva-treated patients was 6.7 months compared with 4.7 months for patients in the placebo group; i.e., the actual gain in survival was 2 months. The time to pain progression was 2.79 months in the Tarceva-treated group vs. 1.91 months in the placebo group, a gain of about 3 weeks. And progression-free survival averaged 2.23 months in the Tarceva-treated group vs. 1.84 months in the placebo group, amounting to a gain of just 12 days. So at best we can expect that the addition of Tarceva may add an average of 2 months to the survival of patients with NSCLC, with a concomitant increase in adverse effects. (Whether the elderly population will respond in similar fashion remains to be seen.) As to Iressa, a 2004 clinical trial found “no added benefit” in survival when Iressa was compared to standard chemotherapy alone (Herbst 2004).

The failure of chemotherapy in NSCLC reminds us that there is still an urgent need for effective preventive strategies as well as for a vigorous exploration of non-conventional approaches to treating the disease.

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  1. […] non-small cell lung cancer (NSCLC) in people 65 and older has a minimal …article continues at Christine brought to you by cancer.medtrials.info and […]


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