Patient-Reported and End-of-Life Outcomes Among Adults With Lung Cancer Receiving Targeted Therapy in a Clinical Trial of Early Integrated Palliative Care: A Secondary Analysis.
Patient-Reported and End-of-Life Outcomes Among Adults With Lung Cancer Receiving Targeted Therapy in a Clinical Trial of Early Integrated Palliative Care: A Secondary Analysis.
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在早期综合姑息治疗临床试验中接受靶向治疗的肺癌成人患者报告和生命终末结局：次要分析
DOI：
10.1016/j.jpainsymman.2021.02.010
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发表时间：
2021-09
影响因子：
4.7
通讯作者：
Greer JA
中科院分区：
文献类型：
--
作者：
Petrillo LA;El-Jawahri A;Gallagher ER;Jackson VA;Temel JS;Greer JA
靶向治疗彻底改变了肺癌治疗并显着提高了生存率，尽管接受靶向治疗的患者报告和临终 (EOL) 结果方面缺乏数据。本研究旨在比较接受靶向治疗的患者和没有靶向突变的肺癌患者的生活质量 (QOL)、症状、预后沟通和 EOL 护理。在对晚期肺癌早期姑息治疗随机试验 (n=154) 的二次分析中，我们使用线性混合效应模型比较了接受靶向治疗的肺癌患者与没有靶向突变的肺癌患者在 24 周内的生活质量和症状变化（根据癌症治疗功能评估 [FACT]-肺量表），并根据接受姑息治疗、年龄和性别进行调整。我们还使用逻辑回归比较了预后沟通和死者的 EOL 医疗保健利用率，并针对姑息治疗进行了调整。与没有靶向突变的个体相比，接受靶向治疗的患者 (n=35) 随着时间的推移，生活质量 (FACT-General B=0.46; 95% CI=0.19, 0.73) 和症状 (FACT-肺癌子量表 B=0.12; 95% CI=0.03, 0.20) 得到了更大的改善，与姑息治疗无关。接受靶向治疗的患者也更有可能报告说，他们很少与临床医生讨论预后（OR=2.59，95% CI=1.01，6.63），并且更有可能在生命的最后 14 天接受癌症定向治疗（OR=14.98，95% CI=4.08，54.96）。相对于没有靶向突变的患者，接受靶向治疗的肺癌患者的生活质量和症状得到改善，在病程早期不太可能讨论预后，更有可能继续治疗直至死亡并在医院去世。
Targeted therapy has revolutionized lung cancer treatment and markedly increased survival, though data are lacking on patient-reported and end-of-life (EOL) outcomes among patients receiving targeted therapy. This study aimed to compare quality of life (QOL), symptoms, prognostic communication, and EOL care between patients receiving targeted therapy and patients with lung cancer without targetable mutations. In this secondary analysis of a randomized trial of early palliative care in advanced lung cancer (n=154), we compared change in QOL and symptoms (per the Functional Assessment of Cancer Treatment [FACT]-Lung scale) over 24 weeks among patients with lung cancer receiving targeted therapy versus those without targetable mutations using linear mixed effects models, adjusted for receipt of palliative care, age and gender. We also compared prognostic communication and decedents’ EOL health care utilization using logistic regression, adjusted for palliative care. Compared to individuals without targetable mutations, patients receiving targeted therapy (n=35) reported greater improvements in QOL (FACT-General B=0.46; 95% CI=0.19, 0.73) and symptoms (FACT-Lung Cancer Subscale B=0.12; 95% CI=0.03, 0.20) over time, independent of palliative care. Patients receiving targeted therapy were also more likely to report they rarely discussed prognosis with their clinicians (OR=2.59, 95% CI=1.01, 6.63) and were more likely to receive cancer-directed therapy in their last 14 days of life (OR=14.98, 95% CI=4.08, 54.96). Relative to patients without targetable mutations, patients with lung cancer who receive targeted therapy experience improved QOL and symptoms, are less likely to discuss prognosis early in their illness course, and more likely to continue treatment until death and die in the hospital.
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影响因子：
8.8
作者：
von Plessen, C;Bergman, B;Andresen, O;Bremnes, R M;Sundstrom, S;Gilleryd, M;Stephens, R;Vilsvik, J;Aasebo, U;Sorenson, S
通讯作者：
Sorenson, S
影响因子：
45.3
作者：
Ferrell, Betty R.;Temel, Jennifer S.;Smith, Thomas J.
通讯作者：
Smith, Thomas J.
影响因子：
2.8
作者：
Bauman, Jessica R.;Piotrowska, Zofia;Temel, Jennifer S.
通讯作者：
Temel, Jennifer S.
影响因子：
45.3
作者：
Bakitas, Marie A.;Tosteson, Tor D.;Ahles, Tim A.
通讯作者：
Ahles, Tim A.
影响因子：
5.3
作者：
CELLA, DF;BONOMI, AE;BONOMI, P
通讯作者：
BONOMI, P