In ways we never could have imagined, the pandemic abruptly pierced the complacency of our daily lives. What was simple became sumptuous. What was common became uncommonly desired—from household goods to hugging friends.
In much the same way, cancer patients experience a catastrophic loss of normalcy. Three words—you have cancer—catapult their lives into chaos, resetting their expectations across every facet of life, from eating and sleeping to working and playing.
Patients must weigh and measure the trade-off between prolonging life and maintaining quality of life, especially those with aggressive cancers whose treatment regimens extract a heavy toll. As one small-cell lung cancer patient noted in an article about her journey, “There is a difference between surviving and living.”
Her viewpoint is not uncommon. A literature review of 30 articles about quality versus length of life revealed that many cancer patients choose quality first, and for a multitude of reasons.
In one such study of patients with advanced cancers, the majority of respondents prioritized quality of life over length of life. Patients in the study stated that they wanted to maintain their activities and not be a burden on family, and therefore not undergo chemotherapy if those factors were compromised.
In another study of patients with advanced cancers, 55 percent placed equal value on quality of life and length of life when weighing both options. When required to commit to a preference, 80 percent of patients chose quality of life.
The literature review noted that, “Some patients are willing to endure toxicities associated with treatment in order to increase their length of life, while others value quality more and are reluctant to spend their remaining years in a compromised state. A trade‐off for potential gain in life expectancy may involve short‐term debility from treatment (postsurgical pain, chemotherapy‐induced nausea and alopecia, etc.) or permanent side effects (stoma, disfigurement, physical dependency, etc.). Moreover, the compromise is not always related to health but instead may be about financial burdens and increased dependency on friends and family.”
Yet all too often, patient preferences are not part of the treatment decision process. In the study of advanced cancer patients’ perspectives, researchers found substantial discordance between how patients versus oncologists reported their consultations about quality of life, with patients perceiving less robust communication on the topic. “This lack of agreement is a potential source of concern insofar as nearly all of the patients taking part in the survey valued quality of life at least as highly as length of life,” the study found.
It is incumbent upon those of us in the drug discovery and development industry to help alleviate this painstaking choice for patients with advanced cancers. We can do so by developing new therapies that aim to support and protect patients throughout cancer treatment, not just aim our drugs at the cancer target and accept the collateral damage as unavoidable.
Targeted therapies are moving us in the right direction, but they aren’t a replacement for chemotherapy, which remains the cornerstone of treatment for many aggressive cancers. Yet chemotherapy often levies debilitating fatigue, shortness of breath, bleeding, and the risk of infection, all of which can compromise quality of life and result in dose reductions, dose delays, and hospitalizations.
We must collectively work toward adopting a new treatment paradigm that focuses on preventing, rather than responding to, these side effects. The pharmaceutical industry is beginning to recognize and respond to this challenge.
In 2021, the FDA approved a medication designed to help protect patients with small-cell lung cancer against bone marrow damage, or myelosuppression.
While this is but one drug in the growing arsenal of supportive care therapies, it incorporates the voice of patients, whose preferences and needs we must respect and follow.
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