Department of Obstetrics and Gynecology Carmel Medical Center, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Support Care Cancer. 2021 Jul;29(7):4055-4064. doi: 10.1007/s00520-020-05961-5. Epub 2021 Jan 6.
Integrative oncology (IO) is increasingly becoming part of palliative cancer care. This study examined the correlation between an IO treatment program and rates of survival among patients with advanced gynecological cancer.
Patients were referred by their oncology healthcare professionals to an integrative physician (IP) for consultation and IO treatments. Those undergoing at least 4 treatments during the 6 weeks following the consultation were considered adherence to the integrative care program (AIC), versus non-adherent (non-AIC). Survival was monitored for a period of 3 years, comparing the AIC vs. non-AIC groups, as well as controls who did not attend the IP consultation.
A total of 189 patients were included: 71 in the AIC group, 44 non-AIC, and 74 controls. Overall 3-year survival was greater in the AIC group (vs. non-AIC, p = 0.012; vs. controls, p = 0.003), with no difference found between non-AIC and controls (p = 0.954). Multimodal IO programs (≥ 3 modalities) were correlated in the AIC group with greater overall 3-year survival (p = 0.027). Greater rates of survival were also found in the AIC group at 12 (p = 0.004) and 18 months (p = 0.001). When compared with the AIC group, a multivariate analysis found higher crude and adjusted hazard ratios for 3-year mortality in the non-AIC group (HR 95% CI 2.18 (1.2-3.9), p = 0.010) and controls (2.23 (1.35-3.7), p = 0.002).
Adherence to an IO treatment program was associated with higher survival rates among patients with advanced gynecological cancer. Larger prospective trials are needed to explore whether the IO setting enhances patients' resilience, coping, and adherence to oncology treatment.
肿瘤整合医学（IO）越来越多地成为姑息治疗癌症的一部分。本研究考察了 IO 治疗方案与晚期妇科癌症患者生存率之间的相关性。
患者由肿瘤医疗保健专业人员转介给整合医师（IP）进行咨询和 IO 治疗。那些在咨询后 6 周内接受至少 4 次治疗的患者被认为是接受了整合护理方案（AIC），而未接受治疗的患者则被认为是非接受者（非 AIC）。对患者进行了 3 年的生存监测，比较 AIC 组与非 AIC 组，以及未接受 IP 咨询的对照组。
共纳入 189 例患者：AIC 组 71 例，非 AIC 组 44 例，对照组 74 例。AIC 组患者的 3 年总生存率更高（与非 AIC 组比较，p=0.012；与对照组比较，p=0.003），而非 AIC 组与对照组之间无差异（p=0.954）。AIC 组中采用多种 IO 方案（≥3 种方案）与 3 年总生存率提高呈正相关（p=0.027）。AIC 组在 12 个月（p=0.004）和 18 个月（p=0.001）时的生存率也更高。与 AIC 组相比，多变量分析发现非 AIC 组和对照组的 3 年死亡率的粗死亡率和调整后危险比更高（HR 95%CI 2.18（1.2-3.9），p=0.010）和 2.23（1.35-3.7），p=0.002）。
接受 IO 治疗方案与晚期妇科癌症患者的生存率提高相关。需要进行更大规模的前瞻性试验，以探讨 IO 环境是否增强了患者对肿瘤治疗的适应能力、应对能力和依从性。
