Decision whether to do chemo with Stage IIA resected NSCLC - 1264369

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mermaid7
Decision whether to do chemo with Stage IIA resected NSCLC - 1264369

Hello - My mom had a lobectomy on April 10 to remove a 7 mm tumor. Her oncologist is recommending 4 rounds of Carbo/Alimpta. She is 72 years old and does not feel well generally. She has been feeling unwell for the last 3 years and, despite a lot of testing (the CT scan that detected the tumor was one of the tests), she has not been able to figure out what is causing her to feel so bad.

I think she was told that she has a 50% chance of recurrence without chemo - and that chemo will increase her overall survival rate by 10%. Does that sound right?

She is concerned about the side effects of chemo and is wondering whether it is worth it for the extra 10%.

It's a tough decision. Any thoughts on what she should be considering?

Thanks!

catdander
Reply To: Decision whether to do chemo with Stage IIA resected

mermiad7, I'm very sorry your mom is in this position. You're asking all the right questions, unfortunately the only person to make the decision is your mom, with help from her family and doctors.

Depending on where the tumor was located a complete resection of a 7mm tumor is thought to not particularly need adjuvant treatment.

This post is written about early stage which is norm the term used for tumors less than 3 cm http://cancergrace.org/lung/2011/08/12/sacrilegious-thoughts-on-adjuvant...

I hope this is helpful. Please let us know if you have more questions,
Janine

catdander
Reply To: Decision whether to do chemo with Stage IIA resected

I've started this new post because I misread 7mm for 7cm, big difference. So I did some quick editing of my first post but want to be clearer.
Dr. Wakelee wrote a post on the subject as has others. About midway through the second pp she says, "The studies have been clear that chemotherapy for patients with small tumors (< 3 centimeters) does not help reduce the risk of the cancer coming back." http://cancergrace.org/lung/2010/05/17/systemic-therapy-for-resected-nsc...

If your mom or you would like to be clear with the oncologist (there are circumstances such as involved malignant lymph nodes or primary tumor in the pleural lining that make the outcome different) a copy of the posts may be helpful. Many do this, me included.

Too, there's a problem with timing of adjuvant tx which oncologists want to be 4-7 weeks post surgery. It sounds as though your mom may be past that point. So there would need to be a discussion about that.

I hope your mom can get back to living her life soon.
All best,
Janine

cards7up
Reply To: Decision whether to do chemo with Stage IIA resected

You've posted it as 7mm which would not require chemo. But as Janine explained, if it's in fact 7cm, then chemo is recommended with a tumor that large. Did she have any lymph node involvement?
Take care, Judy

mermaid7
Reply To: Decision whether to do chemo with Stage IIA resected

Thank you, Janine and Judy. Yes, the tumor was only 7 mm but there was lymph node involvement in the lobe they removed.

It seems like the guidelines clearly point to chemo. She is just so scared and concerned about side effects and quality of life. She doesnt trust that she is being told the full truth.

I think it is okay for her to choose not to do chemo; but given how bad and depressed she feels, I am not sure she is in the position to make a good choice.

She would start June 20 if she does.

Dr West
Reply To: Decision whether to do chemo with Stage IIA resected

Chemotherapy would typically be favored in someone with either a 7 cm cancer (or anything larger than about 4 cm), or a node-positive NSCLC of pretty much any size, but that's presuming that someone is fit enough to do it. The survival benefit of 10% is a reasonable estimate but probably even a bit on the high side unless there were multiple nodes involved. If just a single node, the benefit would probably be closer to 5%.

Also, it's worth highlighting that the trials with post-operative chemotherapy were done in an unusually young, unusually fit population compared with the more general lung cancer population. While your mother is right in the age range of an "average" patient with lung cancer, these trials were done in patients whose median age was 59-62. It may well be that if these trials were done in older and less fit patients (who better represent the real world clinical experience), the benefit could be lower than the risk from chemo.

It ends up as an individualized decision, but post-operative chemotherapy isn't for everyone.

Good luck.
-Dr. West

+++++++++++++++++++++++++
Dr. Howard (Jack) West
Medical Oncologist
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education

biggerten
Reply To: Decision whether to do chemo with Stage IIA resected

I raise my eyebrows when I see comments that she doesn't trust her doctors. If I did not trust my doctor I would find one I did trust. Note, I have never run into one I did not trust.