Ludwig H, Fritz E, Neuda J, Durie B G
1st Department of Medicine and Oncology, Wilhelminenspital, Vienna, Austria.
J Clin Oncol. 1997 Apr;15(4):1672-9. doi: 10.1200/JCO.1997.15.4.1672.
Interferon alfa treatment in multiple myeloma marginally improves relapse-free and overall survival. Often it does so at the expense of toxicity and financial cost. If patients are unwilling or unable to participate in the decision of whether to initiate such treatment, known patient preferences can serve as guidelines for the physician. We interviewed myeloma patients in the United States to obtain information that might facilitate medical decision-making.
Three hundred fifty-five myeloma patients throughout the United States were interviewed by telephone. Without identifying interferon alfa as the treatment agent, interviewers described potential adverse effects, financial cost, and self-injection procedures. The potential benefits of four treatment choices, derived from a meta-analysis of published data, were presented as gains in remission rate (+10%), remission duration (an additional 4 and 7 months, respectively, for induction and maintenance treatment), and overall survival (an additional 3 and 6 months, respectively, for induction and maintenance treatment). Patients' choices for or against use of the unidentified substance were recorded, and interferon was subsequently disclosed as the treatment. The profiles of patients making different choices were determined using multivariate regression techniques.
Approximately half of the patients accepted the unidentified treatment if remission and/or survival improved by at least 6 months. Accepters were younger and more likely to have used interferon. Of patients who rejected the unidentified treatment, 25% to 50% would have been willing to accept it if the benefits were > or = 12 months. Test/retest reliability of all choices, determined in 36 cancer patients, was 0.896.
In multiple myeloma, interferon therapy and, by inference, other treatments with comparable features are acceptable to approximately half of the patients if a 6-month gain in relapse-free or overall survival can be expected.
在多发性骨髓瘤中，干扰素α治疗对无复发生存期和总生存期仅有轻微改善。而且往往是以毒性和经济成本为代价。如果患者不愿意或无法参与是否开始此类治疗的决策，已知的患者偏好可为医生提供指导。我们对美国的骨髓瘤患者进行了访谈，以获取可能有助于医疗决策的信息。
通过电话访谈了美国各地的355名骨髓瘤患者。访谈者在未提及干扰素α为治疗药物的情况下，描述了潜在的不良反应、经济成本和自我注射程序。从已发表数据的荟萃分析中得出的四种治疗选择的潜在益处，以缓解率提高（+10%）、缓解持续时间（诱导治疗和维持治疗分别额外增加4个月和7个月）以及总生存期（诱导治疗和维持治疗分别额外增加3个月和6个月）的形式呈现。记录患者对使用未指明物质的支持或反对选择，随后披露该物质为干扰素。使用多变量回归技术确定做出不同选择的患者特征。
如果缓解期和/或生存期至少延长6个月，约一半的患者接受未指明的治疗。接受者更年轻，且更有可能使用过干扰素。在拒绝未指明治疗的患者中，如果益处≥12个月，25%至50%的患者愿意接受。在36名癌症患者中确定的所有选择的重测信度为0.896。
在多发性骨髓瘤中，如果预计无复发生存期或总生存期能延长6个月，大约一半的患者可接受干扰素治疗，同理，其他具有类似特征的治疗也可接受。
