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PS3 No Chemotherapy — SCE Medical Oncology MCQ

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EasyLung CancerPS3 No ChemotherapySCE Medical Oncology

A 72-year-old man with stage IV NSCLC and poor PS (ECOG 3) has multiple comorbidities. His family ask about the expected benefit of palliative chemotherapy at this performance status. What should they be told?

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Correct answer: A — At ECOG PS 3-4, palliative chemotherapy is more likely to cause harm than benefit

Randomised trials and meta-analyses consistently show that systemic anti-cancer therapy (chemotherapy, immunotherapy) does not improve OS in patients with ECOG PS 3-4 and increases treatment-related toxicity and mortality. NICE NG122 recommends that patients with PS 3-4 be offered best supportive care. The Temel et al NEJM 2010 study showed early palliative care integration improves QoL and may extend survival. Honest communication about prognosis and goals of care is essential.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/cancer