Habraken Jolanda M, ter Riet Gerben, Gore Justin M, Greenstone Michael A, Weersink Els J M, Bindels Patrick J E, Willems Dick L
Department of General Practice, Academic Medical Center, Meibergdreef 15, Amsterdam 1105 AZ, The Netherlands.
J Pain Symptom Manage. 2009 Jun;37(6):973-81. doi: 10.1016/j.jpainsymman.2008.07.010. Epub 2009 Apr 25.
Historically, palliative care has been developed for cancer patients and is not yet generally available for patients suffering from chronic life-limiting illnesses, such as chronic obstructive pulmonary disease (COPD). To examine whether COPD patients experience similar or worse disease burden in comparison with non-small cell lung cancer (NSCLC) patients, we compared the health-related quality of life (HRQOL) scores of severe COPD patients with those of advanced NSCLC patients. We also formally updated previous evidence in this area provided by a landmark study published by Gore et al. in 2000. In updating this previous evidence, we addressed the methodological limitations of this study and a number of confounding variables. Eighty-two GOLD IV COPD patients and 19 Stage IIIb or IV NSCLC patients completed generic and disease-specific HRQOL questionnaires. We used an individual patient data meta-analysis to integrate the new and existing evidence (total n=201). Finally, to enhance between-group comparability, we performed a sensitivity analysis using a subgroup of patients with a similar degree of "terminality," namely those who had died within one year after study entry. Considerable differences in HRQOL were found for physical functioning, social functioning, mental health, general health perceptions, dyspnea, activities of daily living, and depression. All differences favored the NSCLC patients. The sensitivity analysis, using only terminal NSCLC and COPD patients, confirmed these findings. In conclusion, end-stage COPD patients experience poor HRQOL comparable to or worse than that of advanced NSCLC patients. We discuss these findings in the light of the notion that these COPD patients may have a similar need for palliative care.
从历史上看，姑息治疗是为癌症患者发展起来的，对于患有慢性进行性疾病（如慢性阻塞性肺疾病，COPD）的患者来说，目前还不能普遍获得。为了研究与非小细胞肺癌（NSCLC）患者相比，COPD患者是否经历了相似或更严重的疾病负担，我们比较了重度COPD患者与晚期NSCLC患者的健康相关生活质量（HRQOL）得分。我们还正式更新了Gore等人于2000年发表的一项具有里程碑意义的研究所提供的该领域先前证据。在更新先前证据时，我们解决了该研究的方法学局限性以及一些混杂变量。82名GOLD IV级COPD患者和19名IIIb期或IV期NSCLC患者完成了通用和特定疾病的HRQOL问卷。我们使用个体患者数据荟萃分析来整合新的和现有的证据（总计n = 201）。最后，为了提高组间可比性，我们对一组具有相似“终末期”程度的患者进行了敏感性分析，即那些在研究入组后一年内死亡的患者。在身体功能、社会功能、心理健康、总体健康感知、呼吸困难、日常生活活动和抑郁方面，发现HRQOL存在相当大的差异。所有差异都有利于NSCLC患者。仅使用终末期NSCLC和COPD患者的敏感性分析证实了这些发现。总之，终末期COPD患者的HRQOL较差，与晚期NSCLC患者相当或更差。鉴于这些COPD患者可能对姑息治疗有类似需求，我们讨论了这些发现。
