Palliative systemic therapy for advanced non-small cell lung cancer: Investigating disparities between patients who are treated versus those who are not
Palliative systemic therapy for advanced non-small cell lung cancer: Investigating disparities between patients who are treated versus those who are not
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DOI：
10.1016/j.lungcan.2016.04.007
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发表时间：
2016-07-01
期刊：
影响因子：
5.3
通讯作者：
Wheatley-Price, Paul
中科院分区：
文献类型：
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作者：
Brute, Stephanie Y.;Al-Baimani, Khalid;Wheatley-Price, Paul
背景：姑息性系统疗法(ST)治疗晚期非小细胞肺癌(NSCLC)与改善总体生存(OS)和生活质量有关，但许多患者仍未接受治疗。我们探讨了接受和未接受姑息性ST治疗的患者之间的差异，以获得支持和支持未接受治疗的患者的证据。方法：我们对2009至2012年间在我所门诊就诊的新诊断的晚期、不治之症非小细胞肺癌患者进行了回顾性分析。结果：528例患者中，291例(55%)接受姑息性ST段治疗，237例(45%)未接受姑息性ST段治疗。人口统计数据如下：中位年龄67岁，55%男性，50%ECOG表现状态(PS)0-1，48%体重减轻。未经治疗的患者年龄更大(中位数71比，p<；0.01)，健康状况较差(PS 0-1的比例为27%比69%，p<；0.01)，更有可能减肥(57%比41%，p<；0.01)。没有接受治疗的原因包括糟糕的PS(67%)和患者选择(23%)。未经治疗的患者的中位OS较短(3.9个月比10.7个月，HR 1.80[95%C11.4-2.3]，p<；0.01)。在多因素分析中，未接受ST治疗与较短的OS有关。结论：毫不奇怪，未经治疗的患者预后较差，OS较差。然而，令人担忧的是，尽管在活跃的学术中心接受了治疗，但近一半的晚期非小细胞肺癌转诊患者没有接受抗癌治疗。目前的研究主要是寻求改善PS良好患者的治疗结果。这篇综述表明，这是对研究努力的不适当分配。如果我们要提高所有晚期非小细胞肺癌患者的存活率，我们的研究应该更公平地分为表现良好和表现较差的患者组。潜在的策略包括在功能衰退之前进行更快的诊断，以及开发在病情较重的人群中有效和耐受的治疗方法。(C)2016爱思唯尔爱尔兰有限公司。保留所有权利。
Background: Palliative systemic therapy (ST) in advanced non-small cell lung cancer (NSCLC) is associated with improved overall survival (OS) and quality of life, yet many patients remain untreated. We explored differences between patients who did and did not receive palliative ST in order to gain evidence to support and advocate for the untreated.Methods: We performed a retrospective analysis of newly diagnosed patients with advanced, incurable NSCLC seen as outpatients at our institution between 2009 and 2012. Demographics, treatment, and survival data were collected.Results: 528 patients were seen: 291 (55%) received palliative ST, while 237 (45%) received none. Demographics were as follows: Median age 67, 55% male, 50% ECOG performance status (PS) 0-1, 48% with weight loss. Untreated patients were older (median 71 vs. 64, p < 0.01), less fit (PS 0-1 in 27% vs. 69%, p < 0.01), and more likely to have lost weight (57% vs. 41%, p < 0.01). Reasons for no treatment included poor PS (67%) and patient choice (23%). Median OS was shorter amongst untreated patients (3.9 vs. 10.7 months, HR 1.80 [95% C11.4-2.3], p < 0.01). In multivariate analysis, not receiving ST was associated with shorter OS.Conclusion: Unsurprisingly, untreated patients had poorer prognostic features and worse OS. However, it is concerning that, despite being seen in an active academic center, nearly half of all referred patients with advanced NSCLC received no anti-cancer treatment. Current research primarily seeks to improve outcomes in treated patients with good PS. This review suggests that this is an inappropriate allocation of research effort. Our research should be more equitably split between good and poor performance patient groups if we are to improve the survival of all patients with advanced NSCLC. Potential strategies include more rapid diagnosis prior to functional decline, and the development of therapies effective and tolerated in a sicker population. (C) 2016 Elsevier Ireland Ltd. All rights reserved.