Early palliative care in patients with metastatic non-small cell lung cancer

Metastatic or stage IV non-small cell lung cancer (NSCLC) is among the most serious diagnoses that oncologists have to communicate to their patients. In some cases, distant metastases might be found already at initial cancer diagnosis. In others, locoregionally advanced stage III or even earlier disease might evolve into the terminal, disseminated stage. Better treatment options including drugs inhibiting the epidermal growth factor receptor (EGFR) and activated lymphoma kinase (ALK) pathways have been developed, allowing for individually tailored approaches in patients whose tumor cells carry mutations that will render them sensitive to such drugs. Even if there is marked heterogeneity in disease presentation, pathology features, and outcomes, and occasional patients might present with minimal systemic disease such as a single resectable brain metastasis, typical patients have multiple metastases, are elderly, have seriously compromised organ function as a result of comorbidity, and are offered palliative systemic therapy with limited probability of response, possibly supplemented by local measures such as radiation treatment or tracheobronchial stent insertion.