Velindre Hospital, United Kingdom.
Lung Cancer. 2013 Oct;82(1):128-35. doi: 10.1016/j.lungcan.2013.06.023. Epub 2013 Jul 31.
A significant proportion of advanced non-small cell lung cancer (NSCLC) patients receive supportive treatments to manage disease-related symptoms either separately or combined with systemic anti-cancer therapy (SACT). This supportive treatment is commonly referred to as best supportive care (BSC). Definition of BSC in clinical trials and its description in published comparative and real-life NSCLC studies is limited. The lack of a consensus BSC definition makes detailed evaluations of clinical trials and comparisons between clinical trials problematic.
Data were collected as part of the lung cancer economics and outcomes research (LUCEOR) study. Information on treatment and treatment outcomes from deceased stage IIIb/IV NSCLC patients across ten countries was retrospectively collected from medical records. BSC was defined as the best care available as judged by the attending physicians.
A total of 1327 patients' data were analyzed. Of those, 774/1327 (58%), 316/631 (50%), 123/259 (47%), 25/56 (45%) and 15/26 (58%) were administered treatment defined as BSC with first, second, third, fourth and fifth-line SACT respectively. In total, 346/678 (51%), 149/335 (45%), 86/176 (49%), 11/28 (39%) and 13/25 (52%) of patients were administered treatment defined as BSC in the end-of-life setting after finishing first, second, third, fourth and fifth-line SACT respectively. BSC therapies could be grouped into 24 different categories. The most common elements did not vary substantially whether given with SACT (irrespective of treatment line), in the end-of-life setting, or between countries. The commonest categories of BSC were narcotic and non-narcotic analgesics, corticosteroids and gastrointestinal medication.
There were no major differences in what constituted BSC. BSC included in all instances narcotic and non-narcotic analgesics, corticosteroids and gastrointestinal medication. To our knowledge this is the first study attempting to describe BSC in routine clinical practice. This study's results could help define a practical, up to date, evidence-based definition of BSC.
相当一部分晚期非小细胞肺癌（NSCLC）患者接受支持性治疗来管理与疾病相关的症状，这些治疗可以是单独的，也可以与系统抗癌治疗（SACT）联合应用。这种支持性治疗通常被称为最佳支持治疗（BSC）。临床试验中 BSC 的定义以及已发表的比较性和真实世界 NSCLC 研究中对 BSC 的描述均有限。缺乏共识的 BSC 定义使得对临床试验的详细评估以及临床试验之间的比较变得复杂。
数据是作为肺癌经济学和结果研究（LUCEOR）的一部分收集的。回顾性地从病历中收集了来自十个国家的已死亡的 IIIb/IV 期 NSCLC 患者的治疗和治疗结局信息。BSC 的定义为根据主治医生的判断可提供的最佳治疗。
共分析了 1327 例患者的数据。其中，分别有 774/1327（58%）、316/631（50%）、123/259（47%）、25/56（45%）和 15/26（58%）例患者接受了一线、二线、三线、四线和五线 SACT 定义的 BSC 治疗。总共，分别有 346/678（51%）、149/335（45%）、86/176（49%）、11/28（39%）和 13/25（52%）例患者在完成一线、二线、三线、四线和五线 SACT 后在生命末期接受了 BSC 治疗。BSC 治疗可分为 24 种不同类别。无论是否接受 SACT（无论治疗线）、在生命末期或在不同国家，最常见的 BSC 治疗元素都没有明显差异。BSC 最常见的类别包括麻醉性和非麻醉性镇痛药、皮质类固醇和胃肠道药物。
BSC 的组成没有明显差异。BSC 包括所有情况下的麻醉性和非麻醉性镇痛药、皮质类固醇和胃肠道药物。据我们所知，这是首次尝试在常规临床实践中描述 BSC 的研究。本研究的结果可能有助于定义一个实用的、最新的、基于证据的 BSC 定义。
