Tate Wendy R, Skrepnek Grant H
College of Pharmacy, The University of Arizona, Tucson, AZ, USA; The University of Arizona Cancer Center, The University of Arizona, Tucson, AZ, USA.
Psychooncology. 2015 Mar;24(3):253-61. doi: 10.1002/pon.3595. Epub 2014 Jun 11.
Successful cancer treatment is defined as an increase in overall survival and/or progression-free survival. Despite their importance, these metrics omit patient quality of life. Quality-adjusted time without symptoms or toxicity (Q-TWiST) was developed to adjust survival gained, accounting for quality of life. The purpose of this systematic review was to assess the methods reported in cancer literature to determine Q-TWiST values and how these are currently translated to the clinic.
The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were used to conduct a systematic review of studies indexed on MEDLINE and Web of Science through April 2013. Cancer studies that measured Q-TWiST either as a primary outcome or retrospectively and determined utility coefficients from a patient population were identified, and their methods reviewed to determine how the utility coefficient was calculated. Additionally, other relevant factors such as definitions of health states and significant findings were collected and summarized.
Out of 284 studies, 11 were identified that calculated patient-defined utility coefficients. Several methods to determine utility coefficients were reported, and multiple definitions of health state toxicity were applied. Of these studies, seven reported significant differences (p < 0.05) in quality-adjusted survival. No studies, however, directly discussed the clinical relevance of their findings.
Currently, Q-TWiST is utilized as a mathematical theory rather than a clinical tool. Standardization of terminology plus reliability and validity testing of determining both utility coefficients and time frame definitions must be performed before Q-TWiST can become clinically useful to physicians and patients alike for making treatment decisions.
成功的癌症治疗定义为总生存期和/或无进展生存期的延长。尽管这些指标很重要，但它们忽略了患者的生活质量。质量调整无症状或无毒性时间（Q-TWiST）的提出是为了在考虑生活质量的情况下调整所获得的生存期。本系统评价的目的是评估癌症文献中报道的用于确定Q-TWiST值的方法，以及这些方法目前如何应用于临床。
采用系统评价和Meta分析的首选报告项目指南，对截至2013年4月在MEDLINE和科学网上索引的研究进行系统评价。确定将Q-TWiST作为主要结局或进行回顾性测量并从患者群体中确定效用系数的癌症研究，并对其方法进行审查以确定效用系数的计算方式。此外，还收集并总结了其他相关因素，如健康状态的定义和重要发现。
在284项研究中，有11项确定了患者定义的效用系数。报告了几种确定效用系数的方法，并应用了多种健康状态毒性的定义。在这些研究中，有7项报告了质量调整生存期的显著差异（p<0.05）。然而，没有研究直接讨论其研究结果的临床相关性。
目前，Q-TWiST被用作一种数学理论而非临床工具。在Q-TWiST能够对医生和患者在做出治疗决策时都具有临床实用性之前，必须对术语进行标准化，并对效用系数和时间框架定义的可靠性和有效性进行测试。
