Glimelius B, Hoffman K, Graf W, Påhlman L, Sjödén P O
Department of Oncology, Akademiska Sjukhuset, University of Uppsala, Sweden.
Cancer. 1994 Feb 1;73(3):556-62. doi: 10.1002/1097-0142(19940201)73:3<556::aid-cncr2820730310>3.0.co;2-8.
To increase the knowledge about the palliative effects of chemotherapy in patients with symptomatic advanced colorectal cancer, physician- and patient-rated "quality of life" was studied in a randomized multicenter trial comparing a regimen of methotrexate/5-fluorouracil (5-FU) followed by leucovorin rescue (MFL) with a regimen of 5-FU/leucovorin (FLV).
Between January 1989 and December 1990, 70 patients completed a quality of life questionnaire at randomization and after every fourth treatment course. At one of the hospitals, the evaluation was done as an interview (interview group, n = 24), whereas a questionnaire was used at the other hospitals (questionnaire group, n = 46).
Objective responses (complete response plus partial response) were obtained in 15 (21%) patients, subjective responses in 29 (41%) patients, and an overall improved quality of life in 25 (36%) patients. In addition, 16 (23%) patients had unchanged quality of life during at least 4 months. There was a correlation between objective responses, subjective responses, and improvements in quality of life, although discrepancies were noticed, particularly in patients with only slight symptoms. Response rates were higher in the interview group than in the questionnaire group (P < 0.01). This difference could be related to a more favorable outcome when 5-FU was given as a bolus injection, rather than as a short-term infusion (more than 5 minutes).
Improvements or prolonged stabilization of disease in quality of life can be achieved in at least half of the patients with tumor-related symptoms. However, factors related to the administration of chemotherapy may influence this proportion.
为了增加对有症状的晚期结直肠癌患者化疗姑息效果的了解，在一项随机多中心试验中研究了医生和患者评定的“生活质量”，该试验比较了甲氨蝶呤/5-氟尿嘧啶（5-FU）方案加亚叶酸钙解救（MFL）与5-FU/亚叶酸钙（FLV）方案。
1989年1月至1990年12月期间，70例患者在随机分组时以及每四个疗程后完成了一份生活质量问卷。在其中一家医院，评估以访谈形式进行（访谈组，n = 24），而在其他医院则使用问卷（问卷组，n = 46）。
15例（21%）患者获得客观缓解（完全缓解加部分缓解），29例（41%）患者获得主观缓解，25例（36%）患者生活质量总体改善。此外，16例（23%）患者在至少4个月内生活质量未变。客观缓解、主观缓解与生活质量改善之间存在相关性，尽管也注意到存在差异，尤其是在症状较轻的患者中。访谈组的缓解率高于问卷组（P < 0.01）。这种差异可能与5-FU采用大剂量注射而非短期输注（超过5分钟）时更有利的结果有关。
至少一半有肿瘤相关症状的患者可实现生活质量的改善或疾病的长期稳定。然而，与化疗给药相关的因素可能会影响这一比例。
