Symptomatic benefit from gemcitabine and other chemotherapy in advanced non-small cell lung cancer: changes in performance status and tumour-related symptoms.

Results from recent trials challenge the traditional view that chemotherapy offers no survival or quality of life benefits over best supportive care. Meta-analyses of recent trials reveal a modest survival benefit for combination chemotherapy over best supportive care, although there is no strong evidence from randomized trials for superiority of combination over single-agent therapy. In chemotherapy trials where data on performance status change were collected, performance status improved in one-third of patients and remained constant in a further third. Fewer studies have measured changes in specific disease-related symptoms, but there are data from studies with gemcitabine which show improvements in a range of symptoms, including cough, haemoptysis, pain, dyspnoea and anorexia. Thus more patients benefit from chemotherapy than may be suggested by objective response. Surveys have shown that patients are more likely to accept intensive chemotherapy for what are perceived by health care professionals as potentially small benefits. Studies have shown evidence of cost savings associated with chemotherapy over best supportive care.