Vaz-Luis Ines, O'Neill Anne, Sepucha Karen, Miller Kathy D, Baker Emily, Dang Chau T, Northfelt Donald W, Winer Eric P, Sledge George W, Schneider Bryan, Partridge Ann H
Dana-Farber Cancer Institute, Boston, Massachusetts.
Massachusetts General Hospital, Boston, Massachusetts.
Cancer. 2017 Aug 1;123(15):2821-2828. doi: 10.1002/cncr.30671. Epub 2017 Mar 21.
Published studies have suggested that most patients with early stage breast cancer are willing, for modest survival benefits, to receive 6 months of adjuvant cyclophosphamide, methotrexate, and 5-fluorouracil, an older regimen that is used infrequently today. We examined preferences regarding the survival benefit needed to justify 6 months of a contemporary chemotherapy regimen.
The Eastern Cooperative Oncology Group Protocol 5103 was a phase 3 trial that randomized breast cancer patients to receive standard adjuvant doxorubicin, cyclophosphamide, and paclitaxel with either bevacizumab or placebo. Serial surveys to assess quality of life were administered to patients enrolled between January 1, 2010, and June 8, 2010. Survival benefit needed to justify 6 months of chemotherapy by patients was collected at the 18-month assessment. A parallel survey was sent to physicians who had enrolled patients in the study.
Of 519 patients who had not withdrawn at a time point earlier than 18 months, 87.8% responded to this survey. A total of 175 physicians participated. We found considerable variation in patient preferences, particularly for modest survival benefits: for 2 months of benefit, 57% would consider 6 months of chemotherapy, whereas 96% of patients would consider 6 months of chemotherapy for 24 months. Race and education were associated with the choices. Physicians who responded were less likely to accept chemotherapy for modest benefit.
Among patients who received contemporary adjuvant chemotherapy in a randomized controlled trial, we found substantial variation in preferences regarding benefits that justified undergoing chemotherapy. Differences between patients' and physicians' choices were also apparent. Eliciting preferences regarding risks and benefits of adjuvant chemotherapy is critical. Cancer 2017;123:2821-28. © 2017 American Cancer Society.
已发表的研究表明，大多数早期乳腺癌患者愿意为了适度的生存获益接受6个月的辅助性环磷酰胺、甲氨蝶呤和5-氟尿嘧啶治疗，这是一种如今较少使用的较老方案。我们研究了对于采用一种当代化疗方案6个月所需的生存获益的偏好。
东部肿瘤协作组方案5103是一项3期试验，将乳腺癌患者随机分为接受标准辅助性多柔比星、环磷酰胺和紫杉醇联合贝伐单抗或安慰剂治疗。对2010年1月1日至2010年6月8日入组的患者进行系列生活质量评估调查。在18个月评估时收集患者认为接受6个月化疗所需的生存获益。同时向参与该研究患者入组工作的医生发送了一份平行调查问卷。
在18个月之前未退出的519例患者中，87.8%对本次调查作出了回应。共有175名医生参与。我们发现患者偏好存在很大差异，尤其是对于适度的生存获益：对于2个月的获益，57%的患者会考虑接受6个月化疗，而96%的患者会为了24个月的获益考虑接受6个月化疗。种族和教育程度与这些选择相关。作出回应的医生接受为适度获益而进行化疗的可能性较小。
在一项随机对照试验中接受当代辅助化疗的患者中，我们发现对于支持接受化疗的获益的偏好存在很大差异。患者和医生的选择差异也很明显。了解辅助化疗风险和获益的偏好至关重要。《癌症》2017年；123：2821 - 28。©2017美国癌症协会
