Improving Adherence to Cancer Treatment by Addressing Quality of Life in Patients With Advanced Gastrointestinal Cancers
Improving Adherence to Cancer Treatment by Addressing Quality of Life in Patients With Advanced Gastrointestinal Cancers
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DOI：
10.1016/j.jpainsymman.2015.03.005
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发表时间：
2015-09-01
影响因子：
4.7
通讯作者：
Clark, Matthew M.
中科院分区：
文献类型：
--
作者：
Cheville, Andrea L.;Alberts, Steven R.;Clark, Matthew M.
上下文许多具有潜在可治愈癌症的患者由于毒性而没有完成其规定的治疗方案。有证据表明，许多这些毒性的共同终点是服从生活质量（QOL）为导向的干预。本研究旨在确定多学科QOL指导的干预对患者坚持计划化放疗（CR）方案的影响。将两项使用相同QOL干预的随机对照试验的结果汇总，形成61例晚期局限性胃肠道癌患者的队列。在这61名受试者中，29名参加了6至8次每两到三周一次的训练，包括锻炼、教育和放松，32名接受常规医疗护理。主要终点是完成规定的CR方案。次要结果包括CR期间的住院率、术后不良事件发生率和接受新辅助治疗的患者的完全病理学反应。值得注意的是，干预组比对照组有更多的成员完成了计划的CR方案（77.8% vs. 38.2%，P = 0.003）。对照组（n = 14）比干预组（n = 5）有更多的参与者需要住院治疗（P = 0.063）。在接受新辅助CR的患者中，干预组患者按计划完成CR的可能性明显更高（81.0% vs. 37.5%，P = 0.005），住院的可能性更低（14.3% vs. 50.0%，P = 0.011）。向接受CR的患者提供结构化的多学科QOL指导干预可能会增加按计划完成CR的患者比例并减少计划外住院。利用率是QOL指导的干预试验的重要结果。(C)2015年美国临终关怀和姑息医学学会。爱思唯尔公司出版All rights reserved.
Context. Many patients with potentially curable cancer do not complete their prescribed treatment regimens because of the toxicity. There is evidence that the common endpoints of many of these toxicities are amenable to quality of life (QOL)-directed interventions.Objectives. This study was conducted to determine the effect of a multidisciplinary QOL-directed intervention on patients' adherence to planned chemoradiation (CR) regimens.Methods. The results of two randomized controlled trials that used the same QOL intervention were pooled to form a cohort of 61 patients with advanced localized gastrointestinal cancer. Of these 61 subjects, 29 participated in six to eight bi-to triweekly sessions that included exercise, education, and relaxation, and 32 received usual medical care. The primary endpoint was completion of their prescribed CR regimens. Secondary outcomes included hospitalization during CR, rates of adverse postoperative events, and complete pathological response in those undergoing neoadjuvant therapy.Results. Significantly, more members of the intervention than the control group completed their planned CR regimens (77.8 vs. 38.2%, P = 0.003). More participants in the control (n = 14) than the intervention (n = 5) group (P = 0.063) required hospitalization. Among those undergoing neoadjuvant CR, those in the intervention group were significantly more likely to complete CR as planned (81.0% vs. 37.5%, P = 0.005) and less likely to be hospitalized (14.3% vs. 50.0%, P = 0.011).Conclusion. A structured multidisciplinary QOL-directed intervention delivered to patients undergoing CR may increase the proportion of patients who complete CR as planned and reduce unplanned hospitalizations. Utilization is an important outcome in QOL-directed intervention trials. (C) 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.