Pulmonologists have generally taken a nihilistic view of chemotherapy for the treatment of advanced lung cancer. In a study of beliefs among pulmonologists in the therapeutic treatment of lung cancer, Schroen and colleagues found that only one third of those surveyed believed that chemotherapy conferred a survival benefit for patients with stage IV non-small cell lung cancer and 35% said they would refer patients with metastatic cancer directly to a hospice without referral to medical oncology.¹ A survey of British physicians also found that beliefs about the benefits of chemotherapy did not correspond with current medical knowledge and portrayed a more negative impression than the literature would indicate.² There may be legitimate explanations for this difference in perception about outcomes for this patient population. As a group, respiratory physicians may not believe that the small survival benefit achieved with chemotherapy is enough to offset the toxicity associated with treatment. Perhaps we are biased against chemotherapy because we have seen the …