Palliation of symptoms in non-small cell lung cancer: a study by the Yorkshire Regional Cancer Organisation Thoracic Group.
Palliation of symptoms in non-small cell lung cancer: a study by the Yorkshire Regional Cancer Organisation Thoracic Group.
复制标题
非小细胞肺癌症状的缓解：约克郡地区癌症组织胸部小组的一项研究。
作者：
M. Muers;C. Round
背景--尽管大多数非小细胞肺癌的治疗是姑息性的，但关于症状控制充分性的数据很少，也很少有关于适当指标的讨论。方法：289例连续就诊于6位专家的肺癌患者进行了研究; 242例经组织学证实，均为非小细胞肺癌。在出现时和一年内每月两次或直至死亡，由医生在诊所面谈时对12种症状中的每一种进行四点量表分级，分为无症状、轻度、中度或重度。对于每种症状，计算姑息指数（中位控制持续时间/中位生存持续时间），其中控制定义为任何严重程度的症状改善一个或多个级别。结果：64例（22%）患者接受了手术，15例（5%）接受了根治性放疗，107例（37%）接受了姑息性放疗，103例（36%）接受了最佳支持治疗。分析表明，大多数症状随着时间的推移而无情地恶化。咯血的缓解指数为86%，胸痛为73%，咳嗽为34%，呼吸困难为30%;对于全身症状，厌食为54%，不适为47%。许多患者术后姑息性差。呼吸困难是一个特殊的问题，在组有最好的支持性治疗。结论--非小细胞肺癌的大多数症状的频率随着时间的推移而无情地增加，直到不适和厌食症几乎普遍存在。咯血和胸痛比咳嗽和呼吸困难更好地缓解。目前的治疗不能给许多患者足够的缓解，在未来的治疗研究的重点应该是更严重的症状的缓解。
BACKGROUND--Although most treatment for non-small cell lung cancer is palliative, data on the adequacy of symptom control are scanty and there has been little discussion about the appropriate indices. METHODS--Two hundred and eighty nine unselected patients presenting sequentially to six specialists were studied; 242 cases were confirmed histologically and all were managed as non-small cell lung cancer. At presentation and two monthly for one year or until death each of 12 symptoms was graded by a physician at a clinic interview on a four point scale as absent, mild, moderate, or severe. For each symptom a palliative index (median duration of control/median duration of survival) was calculated, where control was defined as an improvement in symptoms of any severity by one grade or more. RESULTS--Sixty four (22%) patients had surgery, 15 (5%) radical and 107 (37%) palliative radiotherapy, and 103 (36%) best supportive care. Analysis showed that most symptoms inexorably worsened with time. The palliation index for haemoptysis was 86%, chest pain 73%, cough 34%, and breathlessness 30%; for systemic symptoms it was 54% for anorexia and 47% for malaise. Palliation was poor in many patients after surgery. Breathlessness was a particular problem in the group having best supportive care. CONCLUSIONS--The frequency of most symptoms in non-small cell lung cancer increases inexorably with time until malaise and anorexia are almost universal. Haemoptysis and chest pain are better palliated than cough and breathlessness. Present treatments fail to give adequate palliation for many patients, and the emphasis in future therapeutic studies should be on the relief of the more severe symptoms.