NHMRC Clinical Trials Centre, University of Sydney, Locked Bag 77, Camperdown, NSW 1450, Australia.
Lung Cancer. 2010 Aug;69(2):141-7. doi: 10.1016/j.lungcan.2010.05.001. Epub 2010 May 31.
Decisions about chemotherapy for NSCLC are complex and involve trade-offs between its benefits, harms and inconveniences. We sought to find, evaluate and summarise studies quantifying the survival benefits that cancer patients judged sufficient to make chemotherapy for NSCLC worthwhile.
A search of MEDLINE identified 5 papers reporting four studies including 270 patients. Two investigators independently extracted and tabulated relevant findings from each study.
Most cancer patients were male, aged over 65 years, had primary lung cancer (65%) and had experienced chemotherapy (62%). Preferences were determined for chemotherapy in metastatic NSCLC (3 papers) and in locally advanced NSCLC (2 papers), but no studies determined preferences for adjuvant chemotherapy. Most cancer patients (>50%) judged moderate survival benefits sufficient to make chemotherapy worthwhile, for example, absolute increases of 10% in survival rates or 6 months in life expectancies. Individual patients' preferences varied widely: benefits judged sufficient ranged from very small (e.g. survival rate of 1%) to very large (e.g. survival rate of 50%). Smaller benefits were judged sufficient to make chemotherapy worthwhile for metastatic rather than locally advanced disease, for less toxic rather than more toxic chemotherapy, and in North American rather than Japanese studies. Four baseline characteristics were weakly associated with judging smaller benefits sufficient: younger age, having dependents, tertiary education and worse quality of life.
The survival benefits patients judged sufficient to make chemotherapy for NSCLC worthwhile were moderate, widely variable, and difficult to predict. Doctors should encourage patients to express their preferences when facing decisions about chemotherapy for NSCLC.
非小细胞肺癌(NSCLC)的化疗决策复杂,涉及到获益、危害和不便之间的权衡。我们试图寻找、评估和总结量化癌症患者认为足以使 NSCLC 化疗值得的生存获益的研究。
对 MEDLINE 进行检索,确定了 5 篇报告了包括 270 例患者的 4 项研究的文献。两名调查员独立地从每项研究中提取和列表相关发现。
大多数癌症患者为男性,年龄超过 65 岁,患有原发性肺癌(65%)并接受过化疗(62%)。在转移性 NSCLC(3 项研究)和局部晚期 NSCLC(2 项研究)中确定了化疗的偏好,但没有研究确定辅助化疗的偏好。大多数癌症患者(>50%)认为中度生存获益足以使化疗值得,例如,生存率提高 10%或预期寿命延长 6 个月。个别患者的偏好差异很大:被认为足以使化疗值得的获益范围从很小(例如生存率为 1%)到很大(例如生存率为 50%)。较小的获益被认为足以使转移性而非局部晚期疾病、毒性较小而非毒性较大的化疗以及北美而非日本的研究值得化疗。四个基线特征与判断较小获益足够相关:年龄较小、有受抚养人、接受过高等教育和生活质量较差。
患者认为足以使 NSCLC 化疗值得的生存获益为中度,差异很大,且难以预测。当面临 NSCLC 化疗决策时,医生应鼓励患者表达自己的偏好。