早期姑息治疗对转移性乳腺癌患者额外化疗疗程的影响：随机研究OSS的结果

Impact of early palliative care on additional line of chemotherapy in metastatic breast cancer patients: results from the randomized study OSS.

作者信息

Chvetzoff Gisèle, Bouleuc Carole, Lardy-Cléaud Audrey, Saltel Pierre, Dieras Véronique, Morelle Magali, Guastalla Jean-Paul, Tredan Olivier, Rebattu Paul, Pop Simona, Ray-Coquard Isabelle, Pierga Jean-Yves, Mignot Laurent, Laurence Valérie, Bourne-Branchu Valérie, Pérol David, Bachelot Thomas

机构信息

Supportive Care Department, Centre Léon Bérard, 28 rue Laennec, 69373, Lyon, France.

University Claude Bernard, Lyon, France.

出版信息

Support Care Cancer. 2022 Dec 27;31(1):82. doi: 10.1007/s00520-022-07561-x.

DOI:10.1007/s00520-022-07561-x

PMID:36574052

Abstract

PURPOSE

The most appropriate criteria and timing for palliative care referral remain a critical issue, especially in patients with metastatic breast cancer for whom long-term chemosensibility and survival are observed. We aimed to compare the impact of early palliative care including formal concertation with oncologists on decision for an additional line of chemotherapy compared with usual oncology care.

METHODS

This randomized prospective study enrolled adult women with metastatic breast cancer and visceral metastases with a 3rd- or 4th-line chemotherapy (CT). Patients received usual oncology care with a palliative care consultation only upon patient or oncologist request (standard group, S) or were referred to systematic palliative care consultation including a regular concertation between palliative care team and oncologists (early palliative care group, EPC). The primary endpoint was the rate of an additional CT (4th or 5th line) decision. Quality of life, symptoms, social support and satisfaction were self-evaluated at 6 and 12 months, at treatment discontinuation or 3 months after discontinuation.

RESULTS

From January 2009 to November 2012, two authorized cancer centers included 98 women (EPC: 50; S: 48). Thirty-seven (77.1%, 95%CI 62.7-88%) patients in the EPC group had a subsequent chemotherapy prescribed and 36 (72.0%, 95%CI 57.5-83.8%) in the S group (p = 0.646). No differences in symptom control and global quality of life were observed, but less deterioration in physical functioning was reported in EPC (EPC: 0 [- 53-40]; S: - 6; 7 [- 60 to - 20]; p = 0.027). Information exchange and communication were significant improved in EPC (exchange, EPC: - 8.3 [- 30 to + 7]; S: 0.0 [- 17 to + 23]; p = 0.024; communication, EPC: 12.5 [- 8 to - 37]; S: 0.0 [- 21 to + 17]; p = 0.004).

CONCLUSION

EPC in metastatic breast cancer patients did not impact the prescription rate of additional chemotherapy in patients a 3rd- or 4th-line chemotherapy for metastatic breast cancer; however, EPC may contribute to alleviate deterioration in physical functioning, while facilitating communication.

TRIAL REGISTRATION

ClinicalTrial.gov identifier: NCT00905281, May 20, 2009.

摘要

目的

姑息治疗转诊的最合适标准和时机仍然是一个关键问题，尤其是在转移性乳腺癌患者中，这类患者具有长期化疗敏感性并可观察到生存情况。我们旨在比较早期姑息治疗（包括与肿瘤学家进行正式会诊）与常规肿瘤治疗相比，对转移性乳腺癌患者决定接受额外化疗疗程的影响。

方法

这项随机前瞻性研究纳入了患有转移性乳腺癌和内脏转移且正在接受三线或四线化疗（CT）的成年女性患者。患者接受常规肿瘤治疗，仅在患者或肿瘤学家要求时接受姑息治疗会诊（标准组，S），或者被转介至系统性姑息治疗会诊，包括姑息治疗团队与肿瘤学家之间的定期会诊（早期姑息治疗组，EPC）。主要终点是决定接受额外化疗疗程（四线或五线）的比例。在6个月和12个月时、治疗终止时或终止后3个月，患者对生活质量、症状、社会支持和满意度进行自我评估。

结果

从2009年1月至2012年11月，两家获批的癌症中心纳入了98名女性患者（EPC组：50名；S组：48名）。EPC组中有37名（77.1%，95%置信区间62.7 - 88%）患者随后接受了化疗处方，S组中有36名（72.0%，95%置信区间57.5 - 83.8%）患者接受了化疗处方（p = 0.646）。在症状控制和总体生活质量方面未观察到差异，但EPC组患者身体功能的恶化程度较小（EPC组：0 [-53 - 40]；S组：-6；7 [-60至-20]；p = 0.027）。EPC组的信息交流和沟通有显著改善（交流，EPC组：-8.3 [-30至+7]；S组：0.0 [-17至+23]；p = 0.024；沟通，EPC组：12.5 [-8至-37]；S组：0.0 [-21至+17]；p = 0.004）。