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Life in the Real World

Frank C. Detterbeck, MD, FCCP
Author and Funding Information

Affiliations: Chapel Hill, NC
 ,  Dr. Detterbeck is Professor of Surgery, Division of Cardiothoracic Surgery, University of North Carolina at Chapel Hill.

Correspondence to: Frank C. Detterbeck, MD, FCCP, Division of Cardiothoracic Surgery, University of North Carolina at Chapel Hill, Medical School Wing C, Room 354, CB 7065, Chapel Hill, NC 27599-7065; e-mail: fdetter@med.unc.edu



Chest. 2005;127(3):699-701. doi:10.1378/chest.127.3.699
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In the past 15 years, there have been numerous publications of clinical trials demonstrating that chemotherapy has a palliative benefit for patients with advanced non-small cell lung cancer (NSCLC).1 These studies have indicated a prolongation of survival (1-year survival of 30 to 40% vs 10%), amelioration of symptoms, and better or at least stable quality of life (QOL), all at the price of either a small cost or in some cases even a cost savings.2 Nevertheless, skeptics argue that the benefits are modest and apply only to very selected patients enrolled in clinical trials.34 This argument suggests that little progress has been made for the majority of patients with advanced NSCLC who are treated outside of the context of a clinical trial. The skeptics assert that the apparent progress is really due merely to better staging (stage migration) and patient selection (the diminishing denominator).

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