Doyle C, Crump M, Pintilie M, Oza A M
Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada.
J Clin Oncol. 2001 Mar 1;19(5):1266-74. doi: 10.1200/JCO.2001.19.5.1266.
The value of palliative chemotherapy in women with refractory and recurrent ovarian cancer is difficult to quantify, and little is known about patient expectations from these treatments. We evaluated in the current prospective study patient expectations, palliative outcomes of chemotherapy, and the inherent resource utilization in patients undergoing second- or third-line chemotherapy for recurrent or refractory advanced ovarian cancer.
The European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire C30 (EORTC QLQ C30) and Functional Assessment of Cancer Therapy-Ovarian (FACT-O) questionnaires were used to assess palliative benefit and an in-house questionnaire was used to gauge patient expectations. The minimal clinically important difference (MCID) was calculated by asking women to make a global rating of change and correlating this to the EORTC QLQ C30. Resource use was recorded and costs were calculated.
Twenty-seven patients were accrued. Objective response was documented on seven of 27. The median survival was 11 months. Sixty-five percent of women expected that chemotherapy would make them live longer and 42% that it would cure them. After two cycles, quality-of-life (QL) improvement was seen particularly in global function (11 of 21) and emotional function (13 of 21) with EORTC QLQ C-30. Improvement was sustained for a median of 2 and 3 months, respectively, in these categories. The MCID was calculated to be 0.39 on a seven-point scale for physical function and 0.13 for global function. The mean total cost per patient for the study period was Can $12,500.
Patient expectations from these treatments are often unrealistic. Although objective responses are low, active palliation with chemotherapy is associated with substantive improvement in patients' emotional function and global QL, with overall costs that seem relatively modest.
姑息化疗对难治性和复发性卵巢癌女性患者的价值难以量化，且对于这些治疗患者的期望了解甚少。我们在当前的前瞻性研究中评估了复发性或难治性晚期卵巢癌接受二线或三线化疗患者的期望、化疗的姑息治疗效果以及内在资源利用情况。
使用欧洲癌症研究与治疗组织生活质量问卷C30（EORTC QLQ C30）和癌症治疗功能评估-卵巢（FACT-O）问卷评估姑息治疗益处，并使用一份内部问卷来衡量患者期望。通过让女性对变化进行整体评分并将其与EORTC QLQ C30相关联来计算最小临床重要差异（MCID）。记录资源使用情况并计算成本。
共纳入27例患者。27例中有7例记录到客观缓解。中位生存期为11个月。65%的女性期望化疗能延长她们的生命，42%期望能治愈她们。两个周期后，使用EORTC QLQ C-30评估发现生活质量（QL）有改善，特别是在整体功能（21例中的11例）和情感功能（21例中的13例）方面。这些类别中的改善分别持续了中位2个月和3个月。计算得出身体功能在七点量表上的MCID为0.39，整体功能为0.13。研究期间每位患者的平均总成本为12,500加元。
患者对这些治疗的期望往往不切实际。尽管客观缓解率较低，但化疗的积极姑息治疗与患者情感功能和整体QL的实质性改善相关，总体成本似乎相对适中。
