Patterns of palliative procedures and clinical outcomes in patients with advanced non-small cell lung cancer

Despite recent progress in palliative chemotherapy for advanced non-small cell lung cancer (NSCLC), the prognosis is still poor. Aside from multiple lines of chemotherapy, many patients need palliative procedures due to disease-related events. The patterns of events requiring palliative procedures and their impact on the clinical course have not been well described.

We evaluated 162 patients who were diagnosed with stage IIIB (with malignant effusion) or IV NSCLC at Seoul National University Hospital in 2005. The patterns of disease-related events requiring palliative procedures, the palliative procedures given, and the clinical outcomes were retrospectively analyzed.

Of the 162 patients, 107 were male (66%) and 55 were female (34%) with a median age of 61 years (range 31-90). Among these patients, 108 patients (66%) received palliative procedures due to disease-related events. Forty-nine patients (30%) needed a palliative procedure at the time of diagnosis, and 59 patients (36%) required palliative procedure later during the course of their treatment. The events requiring palliative procedures were thoracic events (malignant effusion or severe pneumonia requiring intensive care unit care not related to treatment) in 32 (30%), CNS events (brain metastasis or leptomeningeal metastasis) in 37 (34%), skeletal events (bone metastasis requiring radiation, spinal cord compression, hypercalcemia) in 29 (27%), and other events in 10 (9%). The patients who had events at the time of diagnosis showed comparable overall survival to the patients without events at the time of diagnosis (14.6 months vs. 13.3 months, p=0.65). The patients with later events during their course of treatment had a short median survival after the event requiring palliative procedures (median 2.7 months, 95% CI 2.19-3.21).

A considerable proportion of patients with advanced NSCLC receive palliative procedures apart from chemotherapy. These interventions should be taken into consideration for comprehensive cancer care and timely cooperation with palliative care team.