title: Management of advanced lung cancer in resource-constrained settings: a perspective from India.
abstract: Advanced lung cancer (LC) is an important cause of cancer-related morbidity and mortality in resource-constrained settings (RCSs). Cytological/pathological confirmation of diagnosis of LC is essential prior to treatment initiation for ruling out mimickers such as pulmonary tuberculosis. Accurate staging is necessary for optimal management, and investigations should be prioritized based on availability and cost-effectiveness. Platinum-based doublet chemotherapy remains the standard of care for advanced LC. Cost of therapy, lack of medical insurance and frequency of visits are important determinants of treatment regimen. EGF receptor mutation testing may not be readily available in RCSs and chemotherapy should be preferred for unselected patients with advanced non-small-cell lung cancer. Generic drugs may be more affordable than innovator brands. Treatment efficacy should be assessed with traditional end points (survival and objective response rates) as well as those relevant to RCSs (quality of life, toxicity profile and healthcare facility utilization). Issues related to LC treatment in first- and subsequent-line settings in RCSs are discussed in detail in this evidence-based review.
authors.affiliation: Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India. navneetchd@yahoo.com
authors.forename: Navneet
authors.initials: N
authors.lastname: Singh
authors.forename: Ashutosh N
authors.initials: AN
authors.lastname: Aggarwal
authors.forename: Digambar
authors.initials: D
authors.lastname: Behera
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000191:economics / Q000473:pathology / Q000628:therapy*; D003362:Cost-Benefit Analysis; D003906:Developing Countries; D016527:Drug Costs; D016568:Drugs, Generic / Q000191:economics / Q000627:therapeutic use; D017048:Health Care Costs; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007194:India; D008175:Lung Neoplasms / Q000191:economics / Q000473:pathology / Q000628:therapy*; D009367:Neoplasm Staging; D011788:Quality of Life; D016896:Treatment Outcome
chemical_list: D016568:Drugs, Generic