Respiratory Oncology Unit Pulmonology) and Leuven Lung Cancer Group, University Hospital Gasthuisberg, Leuven, Belgium.
J Thorac Oncol. 2012 Aug;7(8):1291-5. doi: 10.1097/JTO.0b013e31825879ea.
Several randomized trials on maintenance therapy (MT) for metastatic non-small-cell lung cancer (NSCLC) have demonstrated benefit in progression-free survival. More recently, a study with pemetrexed and one with erlotinib also showed significant gains in overall survival (OS). Yet, in this palliative treatment setting, the benefit has to be weighed against the potential burden of treatment, and thus patients' preferences should be taken into account.
In the absence of data on this topic, we undertook a pilot survey with 10 questions covering the overall patient attitude toward MT, the benefit expected by patients, and the acceptance of side effects or modes of administration. Included patients had stage IV NSCLC and were planned to start first-line platinum-based doublet chemotherapy. The questionnaire was submitted at the start of and after two and four cycles of chemotherapy.
Thirty patients were included. Overall, patients had a positive attitude toward MT. At baseline, it was considered worthwhile by 83%, 67%, and 43% of patients for an OS benefit of 6, 3, or 1 month, respectively, with some decrease over time. Effects on symptom control were crucial for about 90% of the patients. There was a slight preference for oral versus intravenous administration. Side effects were accepted by most patients as long as they were mild to moderate.
Our pilot survey showed that metastatic NSCLC patients in general are in favor of MT. They expect either an OS benefit of at least several months, or better symptom control, in balance with mild-to-moderate side effects.
几项转移性非小细胞肺癌（NSCLC）维持治疗（MT）的随机试验已经证明了无进展生存期的获益。最近，一项培美曲塞的研究和一项厄洛替尼的研究也显示了总生存期（OS）的显著获益。然而，在这种姑息治疗环境下，获益必须与治疗的潜在负担相权衡，因此应考虑患者的偏好。
在缺乏这方面数据的情况下，我们进行了一项包含 10 个问题的试点调查，涵盖了患者对 MT 的总体态度、患者预期的获益以及对副作用或给药方式的接受程度。纳入的患者患有 IV 期 NSCLC，并计划开始一线铂类双联化疗。问卷在化疗开始时、两个周期后和四个周期后提交。
共纳入 30 例患者。总体而言，患者对 MT 持有积极的态度。在基线时，分别有 83%、67%和 43%的患者认为 MT 对 OS 获益 6、3 或 1 个月是值得的，随着时间的推移，这一比例有所下降。对症状控制的影响对约 90%的患者至关重要。约 90%的患者对口服给药与静脉给药稍有偏好。只要副作用是轻度到中度的，大多数患者都可以接受。
我们的试点调查表明，转移性 NSCLC 患者普遍赞成 MT。他们期望 MT 能带来至少几个月的 OS 获益，或者更好的症状控制，同时伴有轻度到中度的副作用。
