Lee Irwin H, Hayman James A, Landrum Mary Beth, Tepper Joel, Tao May Lin, Goodman Karyn A, Keating Nancy L
Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA.
Int J Radiat Oncol Biol Phys. 2009 Aug 1;74(5):1376-84. doi: 10.1016/j.ijrobp.2008.10.066. Epub 2009 May 4.
To determine the impact of patient age, comorbidity, and physician factors on treatment recommendations for locally advanced, unresectable non-small-cell lung cancer (NSCLC).
We surveyed radiation oncologists regarding their recommendations for treatment (chemoradiation, radiation alone, chemotherapy alone, or no therapy) for hypothetical patients with Stage IIIB NSCLC who varied by age (55 vs. 80 years) and comorbid illness (none, moderate, or severe chronic obstructive pulmonary disease [COPD]). Multinomial logistic regression was used to assess the impact of physician and practice characteristics on radiation oncologists' treatment recommendations for three scenarios with the least agreement.
Of 214 radiation oncologists, nearly all (99%) recommended chemoradiation for a healthy 55 year old. However, there was substantial variability in recommendations for a 55 year old with severe COPD, an 80-year-old with moderate COPD, and an 80-year-old with severe COPD. Physicians seeing a lower volume of lung cancer patients were statistically less likely to recommend radiotherapy for younger or older patients with severe COPD (both p < 0.05), but the impact was modest.
Nearly all radiation oncologists report following the evidence-based recommendation of chemoradiation for young, otherwise healthy patients with locally advanced, unresectable NSCLC, but there is substantial variability in treatment recommendations for older or sicker patients, probably related to the lack of clinical trial data for such patients. The physician and practice characteristics we examined only weakly affected treatment recommendations. Additional clinical trial data are necessary to guide recommendations for treatment of elderly patients and patients with poor pulmonary function to optimize their management.
确定患者年龄、合并症和医生因素对局部晚期、不可切除非小细胞肺癌（NSCLC）治疗推荐的影响。
我们就针对假设的ⅢB期NSCLC患者的治疗推荐（同步放化疗、单纯放疗、单纯化疗或不治疗）对放射肿瘤学家进行了调查，这些患者在年龄（55岁与80岁）和合并症（无、中度或重度慢性阻塞性肺疾病[COPD]）方面存在差异。采用多项逻辑回归来评估医生和执业特征对放射肿瘤学家在三种一致性最低的情况下的治疗推荐的影响。
在214名放射肿瘤学家中，几乎所有（99%）都推荐对健康的55岁患者进行同步放化疗。然而，对于患有重度COPD的55岁患者、患有中度COPD的80岁患者以及患有重度COPD的80岁患者，推荐意见存在很大差异。诊治肺癌患者数量较少的医生在统计学上为患有重度COPD的年轻或老年患者推荐放疗的可能性较小（均p<0.05），但影响不大。
几乎所有放射肿瘤学家都报告称，对于局部晚期、不可切除的NSCLC的年轻且其他方面健康的患者遵循同步放化疗的循证推荐，但对于老年或病情较重的患者，治疗推荐存在很大差异，这可能与缺乏此类患者的临床试验数据有关。我们研究的医生和执业特征对治疗推荐的影响很小。需要更多的临床试验数据来指导老年患者和肺功能差的患者的治疗推荐，以优化他们的管理。
