Maher E J, Dische S, Grosch E, Fermont D, Ashford R, Saunders M, Makepeace A, Korn M, Shah D
Mount Vernon Hospital, Northwood Middlesex HA6 2RN.
Health Trends. 1990;22(2):78-83.
This study investigated the use of radiotherapy for patients perceived to be unsuitable for curative therapy. Patients were grouped according to whether their cancer was considered curable or incurable and whether they received radical or palliative schedules of radiotherapy. The latter group was further evaluated to clarify current practice, to examine the problems in establishing guidelines for treatment and as a basis for prospective audit. Results confirmed that therapy guidelines within the unit were in line with national practice. Changes in standard therapy were proposed in view of resource limitations and recent results from other surveys. A second audit in 1989, together with a formal costing exercise, showed a reduction in the median number of fractions per course in both patient groups. This study suggests that palliative radiotherapy was used selectively for patients likely to receive significant benefit, and that consensus management was practised, and influenced, by informal internal audit. Results highlighted decision-making problems in the management of advanced non-metastasised cancer; confirmed doubts about the advisability of establishing rigid guidelines in palliative therapy; and clarified some of the difficulties in conducting meaningful cost-benefit analyses in this area.
本研究调查了放疗在那些被认为不适合进行根治性治疗的患者中的应用情况。患者根据其癌症被认为是可治愈还是不可治愈，以及他们接受的是根治性还是姑息性放疗方案进行分组。对后一组患者进行了进一步评估，以明确当前的治疗实践，探讨制定治疗指南时存在的问题，并作为前瞻性审计的基础。结果证实，该科室的治疗指南与国家实践相符。鉴于资源限制和其他调查的最新结果，提出了标准治疗方案的变更。1989年的第二次审计以及一次正式的成本核算表明，两个患者组每个疗程的分割次数中位数均有所减少。本研究表明，姑息性放疗是有选择地用于可能从中显著获益的患者，并且通过非正式的内部审计实行并影响了共识管理。结果突出了晚期非转移性癌症管理中的决策问题；证实了对在姑息治疗中制定严格指南的可取性的疑虑；并阐明了在该领域进行有意义的成本效益分析的一些困难。
