Palmer M J, O'Sullivan B, Steele R, Mackillop W J
Kingston Regional Cancer Centre, Toronto, Canada.
Radiother Oncol. 1990 Sep;19(1):17-28. doi: 10.1016/0167-8140(90)90162-p.
Four hundred and sixty-one doctors who treat lung cancer in Canada and the United States answered a questionnaire in which they were asked how they would wish to be managed if they developed non-small cell lung cancer (NSCLC). There was no evidence of a consensus as to preferred treatment in either of two clinical situations described. Personal treatment preferences were significantly influenced by specialist training and each discipline showed a preference for its own modality of treatment. The personal treatment preferences of American and Canadian doctors differed significantly. In the United States, the role of surgery in NSCLC with extensive mediastinal disease was controversial, whereas in Canada, the major controversy was whether any active treatment was desirable in this situation if symptoms were absent. The role of chemotherapy in the treatment of NSCLC with painful bone metastases was controversial in the United States, but the vast majority of Canadian doctors would not wish any form of chemotherapy in this situation. Respondents were also asked what treatment they usually recommended for patients with NSCLC in the two situations described. Almost all these doctors recommended for their patients exactly the same treatment which they would choose for themselves. It was concluded that the personal treatment preferences of doctors are an important factor in determining how patients with NSCLC are treated. Doctors were also asked (a) if they would be willing to participate as patient-subjects in a number of clinical trials for which they would be eligible if they developed NSCLC, and (b) if they would be willing to ask their patients to participate in the same trials. There were significant differences in the perceived acceptability of the trials studied, but in each case a higher proportion of doctors would be willing to ask their patients to participate than would be prepared to consent themselves.
461名在加拿大和美国治疗肺癌的医生回答了一份调查问卷，问卷询问了如果他们患上非小细胞肺癌（NSCLC），他们希望如何接受治疗。在所描述的两种临床情况下，对于首选治疗方法均没有达成共识的证据。个人治疗偏好受到专科培训的显著影响，每个学科都对其自己的治疗方式表现出偏好。美国和加拿大医生的个人治疗偏好存在显著差异。在美国，手术在伴有广泛纵隔疾病的NSCLC中的作用存在争议，而在加拿大，主要争议在于如果没有症状，在这种情况下是否需要任何积极治疗。化疗在治疗伴有疼痛性骨转移的NSCLC中的作用在美国存在争议，但绝大多数加拿大医生在这种情况下不希望进行任何形式的化疗。受访者还被问及他们通常会为所描述的两种情况下的NSCLC患者推荐何种治疗方法。几乎所有这些医生为他们的患者推荐的治疗方法与他们自己会选择的完全相同。得出的结论是，医生的个人治疗偏好是决定NSCLC患者如何接受治疗的一个重要因素。医生们还被问及：（a）如果他们患上NSCLC且符合条件，他们是否愿意作为患者受试者参与一些临床试验；（b）他们是否愿意要求他们的患者参与相同的试验。在所研究的试验的可接受性方面存在显著差异，但在每种情况下，愿意要求患者参与的医生比例都高于愿意自己同意参与的比例。
