Patterns of care for adults with newly diagnosed malignant glioma
Patterns of care for adults with newly diagnosed malignant glioma
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DOI：
10.1001/jama.293.5.557
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发表时间：
2005-02-02
影响因子：
120.7
通讯作者：
Laws, ER
中科院分区：
文献类型：
--
作者：
Chang, SM;Parney, IF;Laws, ER
恶性胶质瘤（III或IV级）患者预后不良，并且几乎没有循证治疗指南。有一个缺乏前瞻性的数据模式的护理为这些patients.Objective提供基准数据，使个人的实践模式和outcome.Design，设置，和患者的胶质瘤结局（GO）项目招募了788例患者在52个临床站点，学术和社区的做法，1997年12月和2000年7月之间。入选标准包括接受第一次或第二次手术诊断或治疗的原发性III级或IV级胶质瘤成人患者。数据收集工具包括在入组时、围手术期和随访间隔3个月直至死亡或最长24个月时提供的问卷调查表。在GO数据库中记录的患者中，565例新诊断的肿瘤患者用于本分析。主要结果测量护理模式（手术管理，围手术期护理，术后管理）。结果大多数患者接受了磁共振成像（n=518; 92%）和肿瘤切除术（n=425; 75%）的尝试。皮质标测（n=107; 19%）和术中图像引导（n=161; 29%）不常见。大多数接受围手术期皮质类固醇（n=535; 99%）和抗癫痫药物（n=497; 88%），但很少接受抗抑郁药（n=38; 8%）或预防性肝素（n=42; 7%）。大多数接受辅助放射治疗（n=479; 87%），但较少接受化疗（n=300; 54%）。学术和社区settings.Conclusions依赖磁共振成像，手术和放疗的实践模式之间的差异显着，是普遍接受的，但是，相对罕见的化疗使用可能与已发表的文献相冲突，频繁使用的预防性抗癫痫药物与既定的实践指南相矛盾。其他实践模式涉及外科手术，预防性肝素和抗抑郁药需要进一步调查，以澄清适当性。建立进一步的临床指南可能有助于减少实践模式的变化。
Context Patients with malignant glioma (grade III or IV) face a poor prognosis, and few evidence-based treatment guidelines are available. There is a dearth of prospective data on patterns of care for these patients.Objective To provide benchmark data to enable comparison of individual practice patterns and outcomes.Design, Setting, and Patients The Glioma Outcomes (GO) Project enrolled 788 patients at 52 clinical sites, both academic and community practices, between December 1997 and July 2000. The enrollment criteria included adult patients with primary grade III or IV glioma undergoing a first or second operation for diagnosis or treatment. The data collection instruments included questionnaire forms given at enrollment, during the perioperative period, and at follow-up intervals of 3 months until death or a maximum of 24 months. Of the patients recorded in the GO database, 565 patients with newly diagnosed tumors were used for this analysis.Main Outcome Measures Patterns of care (surgical management, perioperative care, postoperative management).Results Most patients underwent magnetic resonance imaging (n=518; 92%) and an attempt at tumor resection (n=425; 75%). Cortical mapping (n=107; 19%) and intraoperative image guidance (n=161; 29%) were uncommon. Most received perioperative corticosteroids (n=535; 99%) and antiepileptic medications (n=497; 88%), but few received antidepressants (n=38; 8%) or prophylactic heparin (n=42; 7%). Most received adjuvant radiation therapy (n=479; 87%), but fewer received chemotherapy, (n=300; 54%). Practice patterns varied significantly between academic and community settings.Conclusions Reliance on magnetic resonance imaging, surgery, and radiation is generally accepted; however, relatively infrequent chemotherapy use may conflict with published literature, and frequent use of prophylactic antiepileptic medications contradicts established practice guidelines. Other practice patterns involving surgical adjuncts, prophylactic heparin, and antidepressants require further investigation to clarify appropriateness. Establishing further clinical guidelines may help reduce variability in practice patterns.