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How do you approach the treatment of patients with widespread ES-SCLC with a poor performance status?
How do you decide between supportive care v. chemoimmunotherapy? Is there a threshold of disease burden that would push you towards recommending hospice in order to preserve a patient's QOL?
Answer from: Medical Oncologist at Academic Institution
My basic philosophy for the initial treatment of people with ES-SCLC (or LS-SCLC) with poor PS is to just try to get them going in the right direction without killing them with my treatment. SCLC is usually very responsive to chemotherapy, so you don’t have to beat people with full doses of th...
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Answer from: Medical Oncologist at Academic Institution
When considering therapy for patients with ES-SCLC and poor performance status, I try to gauge how much the cancer is contributing to the poor performance status. If the patient has multiple medical problems then the decision to provide supportive care only is easier. There was an abstract published...
Answer from: Medical Oncologist at Academic Institution
Chemotherapy offers a high response rate and if the cancer is causing symptoms, chemotherapy can play a significant palliative role in improving QOL. Other than that, I try to consider the PS before the diagnosis - if it was an abrupt decline in PS attributed to the cancer, there can be substan...
Answer from: Medical Oncologist at Academic Institution
For poor PS, comfort-directed care is the standard of care.
For patients who were active in the "recent" past but have significant decline in their functional status due to small cell lung cancer, it is reasonable to try chemotherapy. Since SCLC is an aggressive cancer, if the decline in PS is in t...