Non–small-cell lung cancer (NSCLC) has a low long-term survival rate and is the leading cause of cancer- related death globally. Advances in earlier diagnosis, surgery, and radiotherapy treatments have led to more people with NSCLC experiencing long-term survival, however. The term “cure” is often used by patients, clinicians, and policymakers, but these groups often define cure differently. In an effort to clarify the concept of cure and how it is applied in NSCLC, a narrative review of published literature was performed by Morgan and colleagues.
Patients generally define the term cure as free from cancer and that the cancer, even if there is a risk of recurrence, is no longer life-threatening. This is termed “psychological cure.” Quality of life is often of higher importance than survival time to the patient. The psychological cure definition also encompasses patients with indolent cancer or slowly progressive cancer who understand they will not be free from cancer, and the likelihood of dying from another cause is high. Clinicians concentrate on personal cure, which is when patients with cancer are free from cancer cells and the cancer no longer shortens their life expectancies.
Complicating these differences in definition is unclear communication among clinicians, patients, and caregivers, which has been found through surveys to be less than desirable. This analysis found that less than half of newly diagnosed lung cancer patients understood the goal of their treatment and less than half of patients asked their clinician if they have been cured. Oncologists were found to be hesitant to use the term cure, instead often using the term “cancer survivor,” which has a broad definition. Only 40% of surgeons surveyed consistently discussed the possibility of a cure postoperatively with patients. Establishing what the patient already knows and tailoring information to each patient will help clinicians to clearly communicate with their patients.
Epidemiologists consider cure through a different lens, focusing on statistical cure where the cancer population’s mortality rate returns to the same mortality rate as the general population. This assists policymakers to standardize care. Various terms are used in epidemiology when determining statistical cure. Cure models separate fatal cases from those cases with the same mortality as patients in the general population. The cure point, or time to cure, is the length of time from diagnosis to statistical cure, whereas the cure fraction is the proportion of patients still alive. These concepts help to determine statistical cure. In NSCLC, statistical cure is less established than in other cancer types due to the low overall survival rate, but statistical cure occurs around 10 years after diagnosis.
The concept of long-term survival may be easier for patients to understand than the term cure, and clearly explaining the terms cure and survival may help to avoid confusion between clinician and patient.
Source: Morgan H, Ellis L, O'Dowd EL, et al. What is the definition of cure in non-small cell lung cancer? Oncol Ther. 2021;9(2):365-371.
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