Silvestri G, Pritchard R, Welch H G
Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, SC 29425-2220, USA.
BMJ. 1998 Sep 19;317(7161):771-5. doi: 10.1136/bmj.317.7161.771.
To determine how patients with lung cancer value the trade off between the survival benefit of chemotherapy and its toxicities.
Scripted interviews that included three hypothetical scenarios. Each scenario described the same patient with metastatic non-small cell lung cancer with an expected survival of 4 months without treatment. Subjects were asked to indicate the minimum survival benefit required to accept the side effects of chemotherapy in the first two scenarios (mild toxicity and severe toxicity). In the third scenario, subjects were asked to choose between chemotherapy and supportive care when the benefit of chemotherapy was either to prolong life by 3 months or to palliate symptoms.
81 patients previously treated with cis-platinum based chemotherapy for advanced non-small cell lung cancer.
Survival threshold for accepting chemotherapy.
The minimum survival threshold for accepting the toxicity of chemotherapy varied widely in patients. Several patients would accept chemotherapy for a survival benefit of 1 week, while others would not choose chemotherapy even for a survival benefit of 24 months. The median survival threshold for accepting chemotherapy was 4.5 months for mild toxicity and 9 months for severe toxicity. When given the choice between supportive care and chemotherapy only 18 (22%) patients chose chemotherapy for a survival benefit of 3 months; 55 (68%) patients chose chemotherapy if it substantially reduced symptoms without prolonging life.
Patients' willingness to accept chemotherapy for the treatment of metastatic lung cancer varies widely. Many would not choose chemotherapy for its likely survival benefit of 3 months but would if it improved quality of life. The conflict between these patients' preferences and the care they previously received has several explanations, one being that some patients had not received the treatment they would have chosen had they been fully informed.
确定肺癌患者如何权衡化疗的生存获益与其毒性。
包含三种假设情景的书面访谈。每种情景描述的是同一位转移性非小细胞肺癌患者，未经治疗时预期生存期为4个月。在前两种情景（轻度毒性和重度毒性）中，要求受试者指出接受化疗副作用所需的最低生存获益。在第三种情景中，当化疗的获益为延长生命3个月或缓解症状时，要求受试者在化疗和支持治疗之间做出选择。
81例先前接受过顺铂为基础的化疗治疗晚期非小细胞肺癌的患者。
接受化疗的生存阈值。
患者接受化疗毒性的最低生存阈值差异很大。一些患者会为了1周的生存获益而接受化疗，而另一些患者即使有24个月的生存获益也不会选择化疗。接受化疗的中位生存阈值，轻度毒性时为4.5个月，重度毒性时为9个月。当在支持治疗和化疗之间做出选择时，只有18例（22%）患者为了3个月的生存获益选择化疗；如果化疗能在不延长生命的情况下显著减轻症状，55例（68%）患者会选择化疗。
患者接受化疗治疗转移性肺癌的意愿差异很大。许多患者不会为了可能的3个月生存获益而选择化疗，但如果能改善生活质量则会选择。这些患者的偏好与他们之前接受的治疗之间的冲突有多种解释，其中之一是一些患者在充分知情的情况下并未接受他们会选择的治疗。
