Appendix A
Decision Aids
Patient Name: ___
Date: ___/___/___
Lung Cancer Second Line Chemotherapy
What is my chance of being alive at one year if I take chemotherapy, or do best supportive care such as hospice?
Chemotherapy with a drug like docetaxel (Taxotere®) or pemetrexed (Alimta®) improves the chance of being alive at one year by 18 out of 100 people. With chemotherapy, 37 of 100 people were alive at one year. Without chemotherapy, 11 of 100 were alive.
Patients receiving docetaxel (Taxotere®) chemotherapy lived an average of 7.5 months, versus 4.6 months if they did not take chemotherapy. In other words, they lived 2 to 3 months longer.
If you are having cancer-related symptoms that limit your daily activities, the chances of being alive at one year are less than that described above.
The numbers given here are what happens to the average person with this disease in this situation. Half the patients will do better than this, and half will do worse. Your situation could be better or worse. The numbers given for the chance of cure are very accurate. The numbers are given to help you with your own decision making.
What is the chance of my cancer shrinking by half?
About 6 of 100 people will have their cancer shrink by half.
If you are having cancer-related symptoms that limit your daily activities, the chances are less than that described above.
What is the chance of my being cured by chemotherapy?
In this setting, there is no chance of cure. The goal may change to controlling the disease and any symptoms for as long as possible. You may want to talk with your doctor about your own chances and goals of therapy.
How long will chemotherapy make my cancer shrink, if it does?
For all patients who did not get chemotherapy, the average time before the cancer grew was 7 weeks. For patients who got chemotherapy, the average time before the cancer grew was 11 weeks.
What did chemotherapy do to quality of life?
Chemotherapy helped reduce pain scores and did not make quality of life worse.
What are the most common side effects?
The most common side effects will vary with the type of treatment given.
Some of the most common ones include the following:
Mucositis (mouth sores).
Nausea/vomiting; usually controllable.
Alopecia (hair loss).
Neutropenia (low white blood cell count) and infection requiring antibiotics.
Neuropathy (numbness and pain in the hands and feet).
Are there other issues that I should address at this time?
Many people use this time to address a life review–what they have learned during life that they want to share with their families, and planning for events in the future like birthdays or weddings).
Some people address spiritual issues.
Some people address financial issues like a will.
Some people address Advance Directives (Living Wills).
For instance, if you could not speak for yourself, who would you want to make decisions about your care?
If your heart stopped beating, or you stopped breathing, due to the cancer worsening, would you want to have resuscitation (CPR), or be allowed to die naturally without resuscitation?
Some people use this time to discuss with their loved ones how they would like to spend the rest of their life. For instance, where do you want to spend your last days? Where do you want to die?
Do you want to have hospice involved?
These are all difficult issues, but important to discuss with your family and your health care professionals.
