Article and Video CATEGORIES

Cancer Journey

Search By

Denise Brock

Denise has over 30 years of varying experience in the healthcare arena.  In August 2009 she joined The Global Resource for Advancing Cancer Education as one of its first employees.  She has grown with the organization and now oversees the operational movement of programs, efficiency, and effectiveness within the organization, as well as the daily processes and functions.  


Lung Cancer Video Library - Spanish Language: Video #7 What is the best treatment for frail patients with advanced NSCLC?
¿Cuál es el mejor tratamiento para pacientes débiles con cáncer pulmonar de células no pequeñas en estado avanzado?
Denise Brock

For our 7th video in the GRACE Spanish Lung Cancer Library, Antonio Calles, MD, Medical Oncologist, Thoracic Oncology Program, Hospital General Universitario, Gregorio Marraron, Madrid, Spain joined GRACE to discuss the best treatment for frail patients with advanced NSCLC.



TRANSCRIPTS - Spanish and English

¿Cuál es el mejor tratamiento para pacientes débiles con cáncer pulmonar de células no pequeñas en estado avanzado?

Desgraciadamente a veces cuando se diagnostica el cancer de pulmón, el paciente tiene mucha sintomatología derivado de ese tumor, esto es lo que nosotros nos referimos como “performance status” (PS) que es la situación clínica del tumor. Los pacientes que tienen un performance status de 3-4, es decir, que pasan la mayor parte de su día en la cama y no son capaces de autocuidado, se les aconseja el uso de tratamiento y es muy encarecido que reciban terapia paliativa de soporte, no necesariamente de hospicio, puede ser de manera ambulatoria.

Para los pacientes con mejor situación funcional de 0 a 1 están claras las recomendaciones.

La gran duda son los pacientes con un performance status de 2. En primer lugar, porque la definición de un performance status de 2 es ambigua y es difícil definir esta población. Hay PS 2 que realmente son PS 3 y hay PS 2 que realmente son PS 1. Por lo tanto, en la interpretación de los ensayos clínicos, hay que ser cauto porque no sabemos muy bien qué hacer con estos pacientes. En general, la decisión tiene que ser individualizada y tienen que tener gran peso las expectativas del paciente y de su familia. No podemos recomendar de manera sistemática el uso de quimioterapia o de cualquier otro tipo de quimioterapia a los pacientes con PS2 ya que en algunos pacientes el uso de quimioterapia se asocia a mayor toxicidad y en otra mejora la calidad de vida.

Normalmente se suele preferir los esquemas de monoterapia (un solo fármaco) sobre las combinaciones de platino por el riesgo de mayor toxicidad. Recientemente ha habido un estudio en el que comparaba la administración de carboplatino y pemetrexed sobre pemetrexed solo, demostrando un beneficio en supervivencia y control de la enfermedad con la combinación de carboplatino y pemetrexed. La decisión de tratar o no a un paciente con PS2 debe ser individualizada, no hay recomendaciones generales y se deben de basar fundamentalmente en las expectativas del paciente, la familia y las recomendaciones del médico oncólogo. En cualquier caso, todos estos pacientes deben recibir de una manera precoz un tratamiento paliativo de soporte.


Which is the best treatment for weak patients with non-small cell lung cancer in advanced stage?

Unfortunately, sometimes lung cancer is diagnosed in patients with many symptoms from the tumor; this is what we call performance status (PS) which is the clinical situation of the tumor. Patients with a performance status of 3-4, spend most of their day in bed and cannot take care of themselves. They are advised to have a treatment and palliative support therapy, not necessarily from a hospice, it could also be at home.

For patients with a performance status of 0-1 the recommendations are clear.

The big doubt is in patients with a performance status of 2. First of all, because the definition of PS 2 is not clear and it’s harder to define the specific population. There are PS 2 that are truly PS3 and there are also P2 that are PS1. In the interpretation of clinical trials, one has to be careful because we don’t know what to do with these patients. In general, the decision has to be individualized and the most important part are the expectations from the patient and family. We cannot recommend systematically the use of chemotherapy or any other treatment because the result is unknown, so in some patients it can cause toxicity but in others it could improve the quality of life.

 Usually the monotherapies are preferred over combinations with platinum because of the possible toxicity risk. Recently there has been a study where they compared carboplatin and pemetrexed over pemetrexed alone. The result showed an improved in survival and control of the disease using carboplatin and pemetrexed. The decision to treat or not a patient with PS2 is personalized, there are no general recommendations and it the decision has to be based on the patient’s expectative, the family and the oncologist. In any case, all these patients have to receive an early palliative support treatment.

Video Language

Next Previous link

Previous PostNext Post

Related Content

Patient Education Ambassadors 2023-24
  Dr. Gladys Rodriguez and Hannah Manella, RD, discuss addressing nutritional concerns of patients who are undergoing cancer care.  
Head And Neck Cancer Program
Drs. Shetal Patel, Siddharth Sheth, and Jared Weiss discuss the most recent advances in head and neck cancer treatment, including curable and incurable head and neck cancers, thyroid cancers, and HPV positive and negative cancers.  
Lung Cancer OncTalk 2023
At our live event, Lung Cancer OncTalk 2023, Dr. Puneeth Iyengar discusses using radiation therapy in metastatic lung cancer, advances in Oligometastatic disease, (SBRT) for Oligoprogressive, The NRG-LU Trial, and future goals of metastatic NSCLC Treatment.  To watch the complete playlist click here.

Forum Discussions

Canyil, I'm sorry your father and you are going through this. While we can't give urgent help we are her to help offer info and resources to help make the best...

Hello and welcome to Grace.  I'm sorry you're going through this worry.  It is normal to watch a small very slow-growing solid nodule with once-a-year CT scans.  Anything less than a...

Thanks you very much. So in summary the course of action taken suggested by lung specalist (re scan in 12 months) seems appropriate? And a PET at this stage is probably...

I can't say what is appropriate for you that's only something your professionals with all your information can do.  However, when someone has a solid nodule less than a cm that...

A doctor wouldn't nor shouldn't suspect a pancoast tumor with the info you've given.  It's like being in Colorado and hearing hoof beats and assuming it is zebras and not horses. ...

Hello and welcome to Grace.  I'm sorry you're worrying about this but it probably isn't cancer. 


From Adenocarcinoma of the lung: from BAC to the future, "GGNs with diameter...

Recent Comments

Canyil, I'm sorry your…
By JanineT GRACE … on
I can't say what is…
By JanineT GRACE … on
Thanks you very much. So in…
By razp on
A doctor wouldn't nor…
By JanineT GRACE … on