Answer:
C. Offer patients with non–small cell lung cancer and poor performance status palliative care early in the course of the disease.
A 2010 NEJM article attests to the benefit of early palliative care to improve symptom control and survival in patients with non–small cell lung cancer and poor performance status. This patient has a poor prognosis with confirmed non-small cell lung cancer with low performance status and the best course of action is to provide a referral for comprehensive palliative care.
Systemic chemotherapy treatment with a platinum-based doublet regimen has been shown in many studies to increase both overall survival and quality of life in patients with good performance status characterized by the Eastern Cooperative Oncology Group/World Health Organization performance status of at least 2 or less (lower score means better functional status. A score of 2 or less means the patient can carry out all self-care activities and they are also active more than 50% of waking hours. This patient does not meet this definition because as he spends most time in bed and needs help with self-care activities. For a patients like this, studies have shown chemotherapy treatment has no benefit. Instead, chemotherapy is associated with potential harm and significant negative impact on quality of life. Early palliative care in the disease course for patients with metastatic NSCLC has been shown to improve symptom control and improve survival where chemotherapy does not.
Pleurodesis is a procedure that results in obliteration of the pleural space and is helpful in managing recurrent malignant pleural effusion. However, this patient has undergone thoracentesis and has no evidence of recurrent effusion as seen in the most recent X-ray. Therefore, pleurodesis would not be useful for this patient.
Radiation therapy for bone metastases is indicated only for symptom control or for stabilization of a suspected impending fracture. Neither of these is indicated to be an issue for this patient.
Reference
Temel JS, Greer JA, Muzikansky A, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010 Aug 19;363(8):733-42. PMID: 20818875
