Longitudinal Perceptions of Prognosis and Goals of Therapy in Patients With Metastatic Non-Small-Cell Lung Cancer: Results of a Randomized Study of Early Palliative Care
Longitudinal Perceptions of Prognosis and Goals of Therapy in Patients With Metastatic Non-Small-Cell Lung Cancer: Results of a Randomized Study of Early Palliative Care
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DOI：
10.1200/jco.2010.32.4459
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发表时间：
2011-06-10
影响因子：
45.3
通讯作者：
Pirl, William F.
中科院分区：
文献类型：
--
作者：
Temel, Jennifer S.;Greer, Joseph A.;Pirl, William F.
目的了解晚期患者的预后影响医疗决策。本研究的目的是探讨转移性非小细胞肺癌（NSCLC）患者对预后和治疗目标的看法，并研究早期姑息治疗对这些观点的影响。新诊断的转移性NSCLC患者被随机分配接受早期姑息治疗结合标准肿瘤治疗或单独接受标准肿瘤治疗。参与者在6个月的时间里完成了他们对预后和癌症治疗目标的认知的基线和纵向评估。结果我们招募了151名参与者。尽管患有晚期癌症，但三分之一的患者（145名患者中的46名）报告说，他们的癌症在基线时是可以治愈的，大多数患者（124名患者中的86名）认为摆脱所有癌症是治疗的目标。对预后（即治愈率）和治疗目标的基线认知在研究组之间没有显著差异。与接受标准治疗的患者相比，接受早期姑息治疗的患者保留或对其预后进行准确评估的比例更高（82.5% vs 59.6%; P = 0.02）。在早期接受姑息治疗的患者中，对预后有准确认识的患者在临终前接受静脉化疗的可能性较小（9.4% vs 50%; P = 0.02）。结论许多新诊断的转移性非小细胞肺癌患者对其预后的认识不准确。随着时间的推移，早期姑息治疗显著提高了患者对预后的理解，这可能会影响临终前的护理决策。中华临床杂志，29(2):319- 326。(C) 2011年美国临床肿瘤学会
PurposeUnderstanding of prognosis among terminally ill patients impacts medical decision making. The aims of this study were to explore perceptions of prognosis and goals of therapy in patients with metastatic non-small-cell lung cancer (NSCLC) and to examine the effect of early palliative care on these views over time.Patients and MethodsPatients with newly diagnosed metastatic NSCLC were randomly assigned to receive either early palliative care integrated with standard oncology care or standard oncology care alone. Participants completed baseline and longitudinal assessments of their perceptions of prognosis and the goals of cancer therapy over a 6-month period.ResultsWe enrolled 151 participants on the study. Despite having terminal cancer, one third of patients (46 of 145 patients) reported that their cancer was curable at baseline, and a majority (86 of 124 patients) endorsed getting rid of all of the cancer as a goal of therapy. Baseline perceptions of prognosis (ie, curability) and goals of therapy did not differ significantly between study arms. A greater percentage of patients assigned to early palliative care retained or developed an accurate assessment of their prognosis over time (82.5% v 59.6%; P = .02) compared with those receiving standard care. Patients receiving early palliative care who reported an accurate perception of their prognosis were less likely to receive intravenous chemotherapy near the end of life (9.4% v 50%; P = .02).ConclusionMany patients with newly diagnosed metastatic NSCLC hold inaccurate perceptions of their prognoses. Early palliative care significantly improves patient understanding of prognosis over time, which may impact decision making about care near the end of life. J Clin Oncol 29: 2319- 2326. (C) 2011 by American Society of Clinical Oncology