Impact of a Process Optimizing the Decision to Continue or Stop Cancer Treatments in Patients With Advanced Non-small Cell Lung Cancer.

We propose to study the optimization of this decision process in an advanced Non-Small-Cell Lung Carcinoma (NSCLC) population, with a Performance Status (PS) ≥ 2 (median survival of approximately 3 months) piloting iteratively (before each decision to continue treatment) a process consisting of an evaluation framework (30 items to be answered by the oncologist with the patient), consolidating:

• clinical parameters;
• doctors' expectations regarding the continuation of anticancer treatment;
• patient expectations and preferences;
• the possibility of referring the patient to a supportive care specialist and strengthening home care.

The process triggers a dialogue between the patient and the oncologist, based on facts and seeks objectivity, ultimately allowing a shared decision.

In this prospective comparative study, the rate of systemic oncological treatment during the last month of life will be measured consecutively, over a period of usual management, followed by a period of systematic application of a process of optimization of the medical decision.

Inclusion criteria

• Histologically or cytologically proven non-small-cell lung carcinoma (NSCLC) including NSCLC with oncogene addiction.
• Stage IV or IIB/IIIC non irradiable (8th classification TNM, UICC 2015)
• Patient having completed at least one line of chemotherapy in the context of metastatic disease (or in the context of locoregional disease if the last chemotherapy was less than 6 months ago).
• ECOG Performance Status ≥ 2.
• Age ≥ 18.
• Written informed consent.
• Patient capable, according to the investigator, to comply with the requirements of the study.

Exclusion criteria

• Small Cell Lung Cancer (including mixed forms).
• Patient with NSCLC for whom a decision has already been made to permanently discontinue all systemic cancer treatment.
• Impossible follow up for geographical, social or psychological reason.
• Inability to answer a questionnaire (language or neurological barrier).
• Patient under guardianship.
• Patient being treated in a therapeutic trial.
• Patient not covered by social security. -