Effectiveness of Radiotherapy for Non-Small Cell Lung Cancer: An Evidence-Based Essay

This evidence-based essay explores the effectiveness of radiotherapy for non-small cell lung cancer. The study includes a narrative review, a control trial, and a cohort study. The evidence suggests that radiotherapy is effective for early-stage non-small cell lung cancer patients, but not for advanced-stage patients or small cell lung cancer patients.

Running head: EVIDENCE BASED ESSAY
Evidence based essay
Name of the student:
Name of the university:
Author note:

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EVIDENCE BASED ESSAY
Assessment 3
Introduction
As per the recent statistics, lung cancer is one of the leading cause of cancer related
deaths in Australia, it has been reported to be the fifth most common cause of death in
Australia. On a more elaborative note, in 2018, there have been 12741 new cases of Lung
cancer reported in Australia, and in 2018, 9198 deaths have been caused by lung cancer as
well (Lung-cancer.canceraustralia.gov.au, 2018). Hence, lung cancer is a grave health care
concern in Australia, and the radiotherapy has emerged as one of the greatest intervention
techniques.
My interest in the topic has been due to me being a nursing student myself with interest
in chronic care. Radio therapy has emerged as a potent intervention technique for non-
small cell lung cancer (Davis et al., 2015). It is the centre point of debate whether it is an
intervention technique which can significantly outshine the rest of the intervention
technique, especially the harmful and painful chemotherapy.
The aim of this research study had been to discover whether or not radiotherapy can act
as a potent first line of intervention for non-n small cell lung cancer among both male
female patient population.
Best Evidence
Best Practice Level of
Evidence
Study Design In-text Citation in CDU
APA 6th Format
Radiotherapy is safe for
elderly people and high-
risk patients
Level 1 Narrative
review
(Chehade & Palma,
2015)

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EVIDENCE BASED ESSAY
Radiotherapy is not very
effective during
advanced stages of lung
cancer
Level 2 Control trial (DrugWeek, 2012)
Effectiveness of
radiotherapy after
chemotherapy generates
positive results after a
long period of time
Level 4 Cohort study (Hart & Morice, 2015)
Annotated Bibliography
Chehade, S., & Palma, D. A. (2015). Stereotactic radiotherapy for early lung cancer: Evidence-
based approach and future directions. Reports of Practical Oncology &
Radiotherapy, 20(6), 403-410. doi: 10.1016/j.rpor.2014.11.007
This narrative review by Chehade and Palma (2015), aimed to explore the stereotactic
radiotherapy as an intervention for the non-small cell lung cancer that have been detected at an
early stage especially for the inoperable or high risk patients. Chehade had been associated with
faculty of medicine in University of Western Ontario and Palma had been associated with
Department of Radiation Oncology in London Health Sciences Centre. This had been a narrative
review with very limited information available regarding the data collection and analysis. The
results indicated that the stereotactic body radiation therapy is associated with at least more than
90% local control within 3 years of therapy. Along with having a favourable toxicity profile
(Chehade & Palma, 2015). The results have also identified that for patients with severe COPD or
the elderly patients, the Stereotactic body radiation therapy had been identified to provide even
less toxic treatment than surgery or similar oncological interventions. It has to be mentioned that
surgery and chemotherapy, the standard mode of treatment is p0ainful and is far more toxic and
detrimental to the patient and their quality of life (Chang et al., 2015). The authors have concluded
the presence of a large body of evidence supporting the use of stereotactic body radiation therapy

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EVIDENCE BASED ESSAY
in treatment of non-small cell lung cancer.
Drug week. (2012). Common postoperative radiotherapy does not improve survival in older
people with lung cancer. newsrx. p 163. Retrieved from
file:///C:/Users/LAPTOP_MP0251/Downloads/2730033_198433323_artical2forbibliograp
hy%20(1).pdf
This small scale control trial had been carried out by the researchers from the Mount
Sinai School of Medicine that have been identified the use of post-operative radiation
therapy to not be able to prolong life for the patients suffering from non- small cell lung
cancer (Drug week, 2012). The research study identified 1307 cases that had been
suffering from stage 3 non-small cell lung cancer with N2 lymph node from 1992 to 2005
taking the aid of the e Surveillance, Epidemiology and End Results (SEER)- Medicare
registry. Hence the design and sample for the research study had been appropriate. The
results indicated that one year and three year survival had not been improved for patients
that received post-operative radiation therapy. Hence, this article provides a completely
different take to the aim of the assignment negating the need for integration of radiation
therapy in patients. Although, in terms of relevance, it has to be mentioned that the paper
that recommended to avoid use of radiation post-surgical removal, however the aim was to
identify the effectiveness of radiation therapy as an alternative to both surgery and other
treatment modalities.
Hart, S. P., & Morice, A. H. (2015). Radiotherapy for extensive stage small-cell lung cancer. The
Lancet, 385(9975), 1292. Retrieved from
file:///C:/Users/LAPTOP_MP0251/Downloads/2730034_926398553_artical3forbibliograp
hy%20(1).pdf

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EVIDENCE BASED ESSAY
The cohort study by Hart and Morice (2015), aimed to discover which group of
patients are the most benefitted from thoracic radiotherapy after chemotherapy. The author
had been practicing at the Hull York Medical School with specialty in Respiratory
Medicine. This had been a cohort study that involved patients with extensive stage small
cell lung cancer. The sample size is small and there is not enough information available
regarding the data collection and data analysis procedure which is a considerable
drawback or limitation of the study (LoBiondo-Wood & Haber, 2014). The results
indicate that for small cell lung cancer patients that are elderly, chemo-radiotherapy
should not be used unless the exact subtype of the patients are known. Along with that, it
has to be mentioned that the authors also that the chemo-radiotherapy is also ineffective
for elder patients with locally advanced disease (Hart & Morice, 2015).
Justifying the Evidence
The first article by Chehade & Palma (2015), provided a more significantly
optimistic data findings that supported the use of stereotactic body radiation therapy over
any other alternative treatment type for the patients with non-small cell lung cancer. The
authors stated that this intervention can prevent local growth as high as 90% within the
time frame of 3 years. The toxicity level had also been identified as extremely low as
compared to other types of interventions as well. Although the strengths and limitations of
the study had not been identified by the authors, although the extensive detailed analysis
provided by the authors is undoubtedly the biggest strength of the paper. Although, lack of
detail on the data collection and analysis procedure is undoubtedly a severe limitation of
the study (DiCenso, Guyatt & Ciliska, 2014).

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EVIDENCE BASED ESSAY
The second study involved 1307 patients with advanced stage non-small cell lung
cancer, hence undoubtedly the sample size of the research study is undoubtedly a strength
of the study providing enough data (Drug week 2012). However, the study suggested the
radiation therapy to be ineffective for the elderly patients after the surgery, unless the
subtype is known. Although, in this case the lack of adjusting the confounding factors can
be limitation of the data in this case. Along with that, this research study had not been
multicentre, the lack of diversification of the patient profiles selected can also be a
contributor to the difference in the data.
The third and last article involved only 495 patients extensive stage small cell lung
cancer, hence the sample size has been very small (Hart & Morice 2015). The data
findings also indicated the thoracic radiotherapy to be ineffective for the patients with
extensive stage small cell lung cancer, which also contradicts the result of the first article
on the efficiency of radiation therapy. Although, discussing the limitation of the study
includes only 19 patients completing the follow up. The results indicated radiotherapy to
be ineffective after chemotherapy, although very small sample size of the study and
alarmingly low follow up data decreases the reliability of the data.
From the data findings, it can be summarized that only stereotactic body radiation
therapy is effective with low toxicity profile in early stage non-small cell lung cancer
patients. Although, when used after either surgery or chemotherapy, the effects are not as
notable, which affirms the previously published literature (Slotman etv al., 2015).
Similarly, the data also indicated advanced stage patients and small cell lung cancer
patients to not be benefitted from radiation therapy. Hence, the effectiveness of radiation
therapy is limited to early stage diagnosed non-small cell lung cancer patients.
Relevance to Nursing and Barriers to Practice

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EVIDENCE BASED ESSAY
Justifying the three best pieces of evidence that had been selected for the study, firstly
I would like to mention that all three the research studies are recent, authentic and relevant
belonging to different level of evidence to ensure variety and differentiation of evidence in
the assignment. The data is relevant and diverse providing a different insight involving
different patient groups.
Considering the principles of evidence based practice, the evidence meets the
clinical expertise by incorporating the best possible clinical evidence (Dang & Dearholt,
2017). Along with that, the data identified and discussed provided the insight on the
effectiveness of radiotherapy for only non-small scale lung cancer patients detected at
early stage which can help in informing more specialized patient centred and effective
treatment modalities. Hence, the evidence selected address the clinical expertise
successfully and this data can be employed easily in practice to improve clinical practice
(Dang & Dearholt, 2017). The available research evidence and context components of the
evidence based practice had also been addressed effectively by the evidence collected in
the paper as the three data evidences provided data on a diverse patient group and setting.
The data indicates radiotherapy to be only effective for a single patient group, and this will
help informing the context of treatment modes with respect to the best available research
and enhancing the specialization of the modalities.
Although one of the barriers to implementation of the data into practice is the aspect of
patient values which had not been taken into consideration for any of the studies
(Srikrishnan, Fuster & Montgrain, 2018). The articles had not identified any data
regarding the patient perceptions and preferences regarding the choice of radiotherapy in
place of any alternative therapy in practice which will hinder addressing patient values
while implementing the data in practice. Another considerable barrier to practice can be
lack of resources, knowledge and will among the different stakeholders in implementing

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EVIDENCE BASED ESSAY
the radiotherapy for a small patient group such as the early stage non-small cell lung
cancer patients (Pless et al., 2015).
References
Chang, J. Y., Senan, S., Paul, M. A., Mehran, R. J., Louie, A. V., Balter, P., ... & van den Borne,
B. E. (2015). Stereotactic ablative radiotherapy versus lobectomy for operable stage I non-
small-cell lung cancer: a pooled analysis of two randomised trials. The Lancet
Oncology, 16(6), 630-637. doi: 10.1016/S1470-2045(15)70168-3
Chehade, S., & Palma, D. A. (2015). Stereotactic radiotherapy for early lung cancer: Evidence-
based approach and future directions. Reports of Practical Oncology &
Radiotherapy, 20(6), 403-410. doi: 10.1016/j.rpor.2014.11.007
Dang, D., & Dearholt, S. L. (2017). Johns Hopkins nursing evidence-based practice: Model and
guidelines. Sigma Theta Tau. Retrieved from https://books.google.co.in/books?
hl=en&lr=&id=SZU6DwAAQBAJ&oi=fnd&pg=PP1&dq=three+pillars+of+evidence+bas
ed+practice+clinical+exoertise+patinet+values+&ots=_glSztQpz7&sig=7VvZjMHSMUc
Nt1N_lVU6FIaJrfE#v=onepage&q&f=false
Davis, J. N., Medbery, C., Sharma, S., Pablo, J., Kimsey, F., Perry, D., ... & Mahadevan, A.
(2015). Stereotactic body radiotherapy for centrally located early-stage non-small cell lung
cancer or lung metastases from the RSSearch® patient registry. Radiation
Oncology, 10(1), 113. doi: 10.1186/s13014-015-0417-5
DiCenso, A., Guyatt, G., & Ciliska, D. (2014). Evidence-Based Nursing-E-Book: A Guide to
Clinical Practice. Elsevier Health Sciences. Retrevrd from
https://books.google.co.in/books?
hl=en&lr=&id=bHqjBQAAQBAJ&oi=fnd&pg=PR29&dq=principles+of+evidence+based
+practice+in+nursing&ots=M3IsKdDoTJ&sig=nWljxUYMHFxA15FJniw7g5y3YvQ#v=
onepage&q=principles%20of%20evidence%20based%20practice%20in

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EVIDENCE BASED ESSAY
%20nursing&f=false
Drug week. (2012). Common postoperative radiotherapy does not improve survival in older
people with lung cancer.newsrx. p 163. Retrieved from
file:///C:/Users/LAPTOP_MP0251/Downloads/2730033_198433323_artical2forbibliograp
hy%20(1).pdf
Hart, S. P., & Morice, A. H. (2015). Radiotherapy for extensive stage small-cell lung cancer. The
Lancet, 385(9975), 1292. Retrieved from
file:///C:/Users/LAPTOP_MP0251/Downloads/2730034_926398553_artical3forbibliograp
hy%20(1).pdf
LoBiondo-Wood, G., & Haber, J. (2014). Nursing Research-E-Book: Methods and Critical
Appraisal for Evidence-Based Practice. Elsevier Health Sciences. Retrieved from
https://books.google.co.in/books?
hl=en&lr=&id=3tTsAwAAQBAJ&oi=fnd&pg=PP1&dq=principles+of+evidence+based+
practice+in+nursing&ots=JFg_ydNoVX&sig=GzZUSja8hccCpja_vS7XoEmvS4s#v=one
page&q=principles%20of%20evidence%20based%20practice%20in%20nursing&f=false
Lung-cancer.canceraustralia.gov.au, (2018). Lung cancer statistics | Lung cancer. [Online].
Retrieved from https://lung-cancer.canceraustralia.gov.au/statistics. [Accessed on 11th Oct]
Pless, M., Stupp, R., Ris, H. B., Stahel, R. A., Weder, W., Thierstein, S., ... & Zippelius, A.
(2015). Induction chemoradiation in stage IIIA/N2 non-small-cell lung cancer: a phase 3
randomised trial. The Lancet, 386(9998), 1049-1056. Doi: 10.1016/S0140-
6736(15)60294-X
Slotman, B. J., van Tinteren, H., Praag, J. O., Knegjens, J. L., El Sharouni, S. Y., Hatton, M., ... &
Senan, S. (2015). Use of thoracic radiotherapy for extensive stage small-cell lung cancer:
a phase 3 randomised controlled trial. The Lancet, 385(9962), 36-42. doi: 10.1016/S0140-
6736(14)61085-0
Srikrishnan, A., Fuster, M. M., & Montgrain, P. R. (2018). Curative Stereotactic Body
Radiotherapy Is Safe and Effective in Early Stage Non-Small Cell Lung Cancer: A Single-
Center Retrospective Review of a Cohort of Veterans. In D62. TYPES, GENOTYPES,

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AND PHENOTYPES: THE THREE" T's" OF THORACIC ONCOLOGY (pp. A7332-
A7332). American Thoracic Society. doi: 10.1164/ajrccm-conference.2018.197.1