Cancer Care, Alberta Health Services, 10123-99 Street, Suite 1500, Edmonton, Alberta, T5J 3H1 Canada.
Lung Cancer. 2011 Apr;72(1):52-8. doi: 10.1016/j.lungcan.2010.07.005. Epub 2010 Aug 12.
Adjuvant chemotherapy for early stage non-small cell lung cancer was approved for provincial insurance coverage in Alberta, Canada in 2004. The purpose of this study was to measure factors related to uptake of chemotherapy in eligible patients and compare toxicity and survival outcomes in the Alberta population with those found in clinical trials. All Alberta residents diagnosed with stage IB-IIB NSCLC from 2004 to 2006 who had surgery and a consultation with an oncologist to discuss initial treatment were included in the study. Diagnostic, demographic, and vital statistics data were obtained from the Alberta Cancer Registry; chart reviews were conducted to identify details related to treatments discussed, refused, co-morbidities, and toxicity. Analyses were conducted to identify factors associated with discussion and receipt of chemotherapy and toxicity. Toxicity and survival were calculated and compared to clinical trial results. 226 patients were included in the study. Adjuvant chemotherapy was not recommended to 57 patients (25%) and 30 patients (13%) refused chemotherapy. Primary reasons for not recommending chemotherapy were co-morbidities and/or frailty (24 patients). Of the 139 patients who began chemotherapy, 47 (34%) stopped treatment early. Stage II patients who received adjuvant chemotherapy had over a 2-fold decrease in risk of death compared to those who did not receive chemotherapy after adjusting for age and co-morbidities. Efforts to improve uptake of adjuvant chemotherapy in patients with stage II NSCLC should be made as the survival advantage appears to be comparable to that found in clinical trials.
2004 年，辅助化疗被批准纳入加拿大艾伯塔省的省级医疗保险覆盖范围，用于治疗早期非小细胞肺癌。本研究的目的是评估与可接受化疗的患者相关的因素，并比较艾伯塔省患者的毒性和生存结果与临床试验结果。所有在 2004 年至 2006 年间被诊断为 IB-IIB 期非小细胞肺癌的艾伯塔省居民，且已接受手术并与肿瘤学家进行了初始治疗的咨询，都被纳入本研究。诊断、人口统计学和生命统计数据来自艾伯塔省癌症登记处；进行病历回顾以确定与讨论的治疗方法、拒绝的原因、合并症和毒性相关的细节。进行分析以确定与讨论和接受化疗以及毒性相关的因素。计算毒性和生存并与临床试验结果进行比较。本研究共纳入 226 例患者。有 57 例（25%）患者不推荐辅助化疗，有 30 例（13%）患者拒绝化疗。不推荐化疗的主要原因是合并症和/或体弱（24 例）。在开始化疗的 139 例患者中，有 47 例（34%）提前停止治疗。在调整年龄和合并症后，接受辅助化疗的 II 期患者的死亡风险降低了两倍以上，而未接受化疗的患者则没有。应该努力提高 II 期非小细胞肺癌患者接受辅助化疗的比例，因为生存优势似乎与临床试验结果相当。
