Trading treatment toxicity for survival in locally advanced non-small cell lung cancer
Trading treatment toxicity for survival in locally advanced non-small cell lung cancer
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DOI：
10.1200/jco.1997.15.1.330
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发表时间：
1997-01-01
影响因子：
45.3
通讯作者：
Mackillop, WJ
中科院分区：
文献类型：
--
作者：
Brundage, MD;Davidson, JR;Mackillop, WJ
目的：确定患者如何权衡局部晚期非小细胞肺癌（NSCLC）不同治疗策略的潜在生存益处和潜在毒性，具体而言，我们对患者在接受更毒性治疗之前希望获得的生存概率改善感兴趣。患者与方法：参与了56例肺癌或前列腺癌门诊患者（n = 22）和20名临床护士和放射治疗技术人员。对每个参与者进行治疗权衡访谈，比较低剂量与高剂量放疗，高剂量放疗与联合化疗放疗。通过系统地增加毒性更强治疗的假设生存优势，直到患者达到他或她选择毒性更强治疗的阈值，对治疗的偏好进行评估。结果：两组均观察到广泛的阈值。胰腺癌和前列腺癌患者的生存优势阈值分布无显著差异，但普遍低于工作人员申报的阈值。如果3年生存优势达到10%，则60%的患者和15%的工作人员会考虑联合治疗而不是高剂量放疗，在患者中，考虑更多毒性治疗的明显意愿与年龄、性别、教育程度或决策中的首选角色无关，治疗权衡法具有良好的重测信度。局部晚期非小细胞肺癌患者接受积极治疗的意愿存在很大的个体差异。在选择非小细胞肺癌治疗时，应向每位患者提供有关治疗方案的全面信息，以便患者在希望参与决策时表达自己的偏好。(C) 1997年由美国临床肿瘤学会。
Purpose: To determine how patients weigh potential survival benefits against the potential toxicity of different treatment strategies for locally advanced non-small cell lung cancer (NSCLC), Specifically, we were interested in what improvement in survival probability patients would want to have before accepting more toxic therapy.Patients and Methods: Fifty-six outpatients who herd experienced lung cancer (n = 22) or prostate cancer (n = 34), and 20 clinic nurses and radiation therapy technologists participated. A treatment trade-off interview was conducted with each participant that compared low-dose versus high-dose radiotherapy and high-dose radiotherapy versus combination chemo-radiotherapy. Preferences for treatments were assessed by systematically increasing the hypothetical survival advantage of the more toxic treatment until the person reached his or her threshold for choosing the more toxic treatment,Results: A wide range of thresholds was observed for both groups. The distributions of survival advantage thresholds for sung cancer and prostate cancer patients were not significantly different but were generally lower thresholds than those declared by staff. If the 3-year survival advantage wets 10%, 60% of patients and 15% of staff would consider combination therapy over high-dose radiotherapy, Within patients, apparent willingness to consider more toxic treatments was not significantly related to age, sex, education, or preferred role in decision making, The treatment trade-off method had good test-retest reliability,Conclusion: There is great interindividual variability in willingness to accept aggressive treatments for locally advanced NSCLC, When choosing NSCLC treatment, each patient should be provided with comprehensive information about the options so that he or she may express his or her preferences should he or she wish to participate in the decision. (C) 1997 by American Society of Clinical Oncology.