Panel Discusses How to Talk to Patients About Starting Lung Cancer Treatment

A roundtable discussion, moderated by Millie Das, MD, covered challenges, advances, and future directions for the diagnosis, treatment, and management of non-small cell lung cancer (NSCLC), as well as critical clinical trial data and updates from the 2024 American Society of Clinical Oncology Annual Meeting. Dr. Das was joined by Ticiana Leal, MD, Martin Dietrich, MD, PhD, and Kent Shih, MD.

In the second segment of the roundtable series, the panel discusses how to talk to patients about starting treatment for NSCLC, what to do while awaiting next-generation sequencing (NGS) testing results, and how to help patients navigate treatment options and quality-of-life considerations.

View the next segment of the series on unmet needs in lung cancer.

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Dr. Das: On that topic of concerns about delays and getting started on treatment, Martin, you mentioned patients are presenting symptomatic, how are you framing your discussions about treatment? When we see these metastatic patients, especially those who are symptomatic, they want to start on treatment tomorrow.

If you’re still waiting on NGS testing, how are you talking to them about that? How are you discussing prognosis with them without that information? I’ll open it up to any of you to start.

Dr. Shih: I mean, I think if they need treatment, we’ll start them on chemotherapy. We may have to add the immunotherapy later or switch to tyrosine kinase inhibitors later, but if they’re sick and they need treatment, we’ll usually get the chemo started and then nuance later.

Dr. Dietrich: Yeah, similar approach. I mean, if there’s a localized lesion of concern, obviously radiation is probably better. But I tell the patients that the diagnosis is simply not complete and that the best course of therapy, including sort of an assessment of response and prognosis is just simply not possible yet. It’s an ask for patients in the beginning to ensure that we give the right patient the right treatment at the right time.

Dr. Leal: In that initial visit, a lot of times you’re breaking down a lot of information. I think the first thing that I try to do is really assess: Where is the patient at? How much information do they know? How much information are they ready to receive? They’ll ask questions and I’ll open it up for discussion, and then kind of get a sense of where they’re at.

Certainly, for patients that don’t have the complete information, it’s kind of that education about: “This is what we need in order to fully understand where your cancer’s at, the stage, and then importantly, we can define the treatment and talk about prognosis. Although we don’t have all that information today, next time we see each other, we’re going to have all that information, and then we’ll be able to sort of define.”

For the patients that are, as everyone said, acutely ill, then certainly, initiating chemotherapy is certainly the way to go. But I have found that for the majority of people, if you have this conversation and you’re working on perhaps symptom management, you’re managing pain, radiation [and] palliative care can weigh in as well—you’re able to gain some time. Because honestly, I’ve found that unless that patient acutely needs chemotherapy, it’s 1 cycle of chemotherapy, and if you find that genomic alterations that you’re going to act on—which could be just 10 days with plasma testing—you really are not going to get the benefit from chemotherapy.

So, when I have that discussion with patients, [I say] “We’re going to get 1 cycle in, we’re going to get your results within those 3 weeks, and that’s not enough to really make an impact on the cancer, but you may have some side effects from the [intravenous] chemotherapy. So, we could spare you from that if we are able to wait 2 weeks.” I found that when you have that discussion, patients a lot of times will say, “Well, that makes sense. I’d rather wait. Let’s manage the pain, let’s work on this. Let’s complete the work-up.”

Dr. Das: I think talking to patients about quality of life—that’s when we’re presented with these patients who have metastatic disease—I think it is important to talk to them about really the goals of not only extending their life, but also giving them better quality of life and really having those discussions, and once we have the data back, to talk about the pros and cons of treatment and to move forward from there.

View the first segment of this roundtable series here.