Chemotherapy versus supportive care in advanced non-small cell lung cancer: improved survival without detriment to quality of life

BACKGROUND: In 1995 a meta-analysis of randomised trials investigating the value of adding chemotherapy to primary treatment for non-small cell lung cancer (NSCLC) suggested a small survival benefit for cisplatin-based chemotherapy in each of the primary treatment settings. However, the metaanalysis included many small trials and trials with differing eligibility criteria and chemotherapy regimens. METHODS: The aim of the Big Lung Trial was to confirm the survival benefits seen in the meta-analysis and to assess quality of life and cost in the supportive care setting. A total of 725 patients were randomised to receive supportive care alone (n = 361) or supportive care plus cisplatin-based chemotherapy (n = 364). RESULTS: 65% of patients allocated chemotherapy (C) received all three cycles of treatment and a further 27% received one or two cycles. 74% of patients allocated no chemotherapy (NoC) received thoracic radiotherapy compared with 47% of the C group. Patients allocated C had a significantly better survival than those allocated NoC: HR 0.77 (95% CI 0.66 to 0.89, p = 0.0006), median survival 8.0 months for the C group v 5.7 months for the NoC group, a difference of 9 weeks. There were 19 (5%) treatment related deaths in the C group. There was no evidence that any subgroup benefited more or less fromchemotherapy. No significant differences were observed between the two groups in terms of the pre-defined primary and secondary quality of life end points, although large negative effects of chemotherapy were ruled out. The regimens used proved to be cost effective, the extra cost of chemotherapy being offset by longer survival. CONCLUSIONS: The survival benefit seen in this trial was entirely consistent with the NSCLC meta-analysis and subsequent similarly designed large trials. The information on quality of life and cost should enablepatients and their clinicians to make more informed treatment choices

Integration of a Case-Based Online Module into an Undergraduate Curriculum: what is involved and is it effective?

Numerous studies have been undertaken demonstrating that online learning is an effective teaching tool, working best when combined with more conventional teaching methods. There is a paucity of data both examining the longitudinal blending of an e-module with more conventional modes of curriculum delivery and also relating to the time and financial costs involved in successful delivery of such a module. The study reported in this article was performed over an academic year in a cohort of 101 year 5 medical students. It demonstrates that there are significant set-up costs involved in designing and implementing an online module, although these costs will diminish following initial set-up. Surveys performed throughout the year demonstrated consistently high levels of student satisfaction, with appreciation of the educational benefits provided by e-learning. Successful clinician engagement and effective IT support are essential ingredients to success. Future research is likely to focus on outcome evaluations of e-learning and how it may affect learner knowledge, skills or attitudes