Gynecol Oncol. 2017 Aug;146(2):392-398. doi: 10.1016/j.ygyno.2017.05.039.
It is our belief that patient preference should play a significant role in disease management of recurrent ovarian cancer. Since cure is seldom an endpoint in this circumstance, patients' attitudes toward the risks and benefits of chemotherapy versus palliation are relevant.
Medline, Embase, CINAHL and PsycINFO from were searched from January 1, 2000 to December 13, 2016 for studies of values, preferences or expectations of women with platinum-sensitive recurrent or refractory ovarian cancer.
Ten studies representing five countries met inclusion criteria. Although there was regional variation in preference for palliation over treatment, certain themes emerged. 1) Patients, even in the context of counselling overestimated the curative capability of chemotherapy. In one study 92% of patients had high expectations of healing after completing an expectation of treatment checklist. Another study observed that patients are often overwhelmed by information provided at diagnosis and there can be a discrepancy between what patients report to have heard and what the clinicians said. 2) Patients who had previously tolerated chemotherapy well were more likely to be accepting of the side-effects of chemotherapy. 3) Patients were more willing to accept chemotherapy and the related side effects when treatment was of curative intent or when overall survival was increased. 4) Patients valued both overall and progression free survival. 5) A significant minority (24%) consistently chose treatment over palliation. 6) Patients were more willing to accept the side effects of chemotherapy than were their health care providers.
These findings, in aggregate, highlight the importance of communication with patients regarding prognosis, adverse effects and symptom management to help negotiate the decision making process. Chemotherapy in the recurrent setting should be managed on a case by case basis, combining both medical constraints and consideration to patient preferences.
我们认为患者偏好应在复发性卵巢癌的疾病管理中发挥重要作用。鉴于在这种情况下治愈很少是一个终点，患者对化疗与姑息治疗的风险和益处的态度是相关的。
检索了2000年1月1日至2016年12月13日期间的Medline、Embase、CINAHL和PsycINFO数据库，以查找关于铂敏感复发性或难治性卵巢癌女性的价值观、偏好或期望的研究。
代表五个国家的十项研究符合纳入标准。尽管在对姑息治疗而非治疗的偏好上存在地区差异，但出现了某些共同主题。1）即使在接受咨询的情况下，患者也高估了化疗的治愈能力。在一项研究中，92%的患者在完成一份治疗期望清单后对治愈抱有很高期望。另一项研究观察到，患者常常被诊断时提供的信息弄得不知所措，患者报告听到的内容与临床医生所说的内容之间可能存在差异。2）先前对化疗耐受性良好的患者更有可能接受化疗的副作用。3）当治疗具有治愈意图或总生存期延长时，患者更愿意接受化疗及相关副作用。4）患者重视总生存期和无进展生存期。5）相当少数（24%）的患者始终选择治疗而非姑息治疗。6）患者比其医疗服务提供者更愿意接受化疗的副作用。
总体而言，这些发现凸显了与患者就预后、不良反应和症状管理进行沟通以帮助协商决策过程的重要性。复发性卵巢癌的化疗应根据具体情况进行管理，综合考虑医学限制和患者偏好。
