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Case History

Image not available. A patient has completed a course of chemotherapy and attends for the results of their post-treatment computed tomography (CT) scan. The reports reads: In the thorax, both previously noted metastatic deposits have reduced in size. The right mid-zone lesion now measures 4.5 cm by 2 cm compared with 5 cm by 3.5 cm previously. The left apical nodule which was previously 7 mm by 5 mm is no longer seen. However, in the upper abdomen, a 2 cm lesion is now noted in the liver, which was not scanned in the previous investigation.

How do you evaluate the patient's response to chemotherapy?

How do the methods apply to the patient?

What will you say to the patient?

Background

How do you evaluate the patient's response to chemotherapy?

Image not available. Response to chemotherapy in a patient with metastatic disease can be assessed by several approaches. These include subjective and objective methods of assessing disease response. When a patient is started on treatment it is important at the outset to ascertain how their disease will be monitored, taking into consideration the method of monitoring (which may be a combination of methods), the frequency of monitoring, and the implication of the results for further management.

Clinical assessment

Patients receiving chemotherapy will have regular clinical reviews prior to, during and following completion of their chemotherapy. These reviews provide an opportunity to assess clinically the patient's response to their treatment. The patient can be asked about symptomatic improvement which may have occurred following completion of chemotherapy, for example, pain, anorexia, breathlessness, fatigue. There is a possibility of bias in both the patient's reporting of their condition and the interpretation of the information by the physician.

Scoring systems have been developed to try to standardise assessment of clinical response. These were initially developed for use in clinical trial settings but are now commonly used in medical practice, for example, the scoring systems used to assess performance status of patients. Commonly used tools are the Karnofsky score and the World Health Organization (WHO)/Eastern Cooperative Oncology Group (ECOG) performance score (see Appendix 1.1).

In clinical studies, quality of life of patients has also been evaluated when determining response to treatment. Studies have shown that there is often a significant correlation between quality of life reported by the patient, symptom improvement and objective tumour regression.1 Assessment with scoring systems can be a valuable means of monitoring patient response. Routine use in clinical practice may sometimes be difficult as time during a consultation is often limited, and patients may find it difficult to complete the sometimes complex questionnaires. Studies, however, have shown that the integration of quality-of-life questionnaires in routine practice is feasible, and has a positive impact on patient-doctor communication and the patient's functional and emotional wellbeing.2

Clinical examination also may provide ...

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