More patients benefit by the reduction of tumor-related symptoms from gemcitabine chemotherapy than is suggested by the objective response rate. Cough, in particular, was improved for 2 to 5 months by gemcitabine alone in 44% of all subjects with cough, and in 73% of those with moderate or severe cough.- This relief of cough by gemcitab-ine monotherapy, which has a much lower toxicity profile than platinum-based chemotherapy programs in combination with other agents, is comparable to the reported frequency of cough relief with external radiation.
A review of multiple randomized trials of both palliative radiotherapy and chemotherapy was performed to assess the impact of anticancer treatments on quality of life in patients with advanced NSCLC. In almost all of the studies cited, patients completed questionnaires as the method of assessing a reduction of cough frequency or severity. this
Objective methods, such as cough counting by the patient or an observer, are not reported. The subjective rate of palliation of local symptoms is high, with cough controlled in 50 to 70% of patients. The control of symptoms seems to be best among patients with good overall performance status, small losses of body weight, and age < 70 to 75 years, although some studies have supported the use of chemotherapy in patients with poor prognostic features. Cough associated with small cell lung cancer improves in 7 to 80% of patients with chemotherapy for small cell lung cancer.
Central airway obstruction (ie, significant obstruction of the trachea and main bronchi) can cause life-threatening dyspnea and hemoptysis, and intractable cough. Cough can be palliated by endobronchial treatment methods, but the relief of cough is seldom a reason to offer such treatment if dyspnea or hemoptysis are not also present.