Massachusetts General Hospital, Boston, MA 02114, USA.
N Engl J Med. 2010 Aug 19;363(8):733-42. doi: 10.1056/NEJMoa1000678.
BACKGROUND: Patients with metastatic non-small-cell lung cancer have a substantial symptom burden and may receive aggressive care at the end of life. We examined the effect of introducing palliative care early after diagnosis on patient-reported outcomes and end-of-life care among ambulatory patients with newly diagnosed disease. METHODS: We randomly assigned patients with newly diagnosed metastatic non-small-cell lung cancer to receive either early palliative care integrated with standard oncologic care or standard oncologic care alone. Quality of life and mood were assessed at baseline and at 12 weeks with the use of the Functional Assessment of Cancer Therapy-Lung (FACT-L) scale and the Hospital Anxiety and Depression Scale, respectively. The primary outcome was the change in the quality of life at 12 weeks. Data on end-of-life care were collected from electronic medical records. RESULTS: Of the 151 patients who underwent randomization, 27 died by 12 weeks and 107 (86% of the remaining patients) completed assessments. Patients assigned to early palliative care had a better quality of life than did patients assigned to standard care (mean score on the FACT-L scale [in which scores range from 0 to 136, with higher scores indicating better quality of life], 98.0 vs. 91.5; P=0.03). In addition, fewer patients in the palliative care group than in the standard care group had depressive symptoms (16% vs. 38%, P=0.01). Despite the fact that fewer patients in the early palliative care group than in the standard care group received aggressive end-of-life care (33% vs. 54%, P=0.05), median survival was longer among patients receiving early palliative care (11.6 months vs. 8.9 months, P=0.02). CONCLUSIONS: Among patients with metastatic non-small-cell lung cancer, early palliative care led to significant improvements in both quality of life and mood. As compared with patients receiving standard care, patients receiving early palliative care had less aggressive care at the end of life but longer survival. (Funded by an American Society of Clinical Oncology Career Development Award and philanthropic gifts; ClinicalTrials.gov number, NCT01038271.)
背景：转移性非小细胞肺癌患者的症状负担很大，在生命末期可能会接受积极的治疗。我们研究了在初诊时引入姑息治疗对新诊断为疾病的门诊患者的患者报告结局和临终关怀的影响。
方法：我们将新诊断为转移性非小细胞肺癌的患者随机分为早期姑息治疗联合标准肿瘤治疗组或标准肿瘤治疗组。使用癌症治疗功能评估-肺（FACT-L）量表和医院焦虑抑郁量表分别在基线和 12 周评估生活质量和情绪。主要结局是 12 周时生活质量的变化。从电子病历中收集临终关怀数据。
结果：在 151 名接受随机分组的患者中，27 名在 12 周内死亡，107 名（其余患者的 86%）完成了评估。接受早期姑息治疗的患者生活质量优于接受标准治疗的患者（FACT-L 量表评分[范围为 0 至 136，分数越高表示生活质量越好]，98.0 对 91.5；P=0.03）。此外，姑息治疗组中出现抑郁症状的患者比例低于标准治疗组（16%对 38%，P=0.01）。尽管接受早期姑息治疗的患者比接受标准治疗的患者接受积极的临终关怀的比例较低（33%对 54%，P=0.05），但接受早期姑息治疗的患者中位生存期更长（11.6 个月对 8.9 个月，P=0.02）。
结论：在转移性非小细胞肺癌患者中，早期姑息治疗可显著改善生活质量和情绪。与接受标准治疗的患者相比，接受早期姑息治疗的患者在生命末期接受的积极治疗较少，但生存期更长。（由美国临床肿瘤学会职业发展奖和慈善捐赠资助；ClinicalTrials.gov 编号，NCT01038271）。
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