Preferences for chemotherapy in patients with advanced non-small cell lung cancer: descriptive study based on scripted interviews

被引:274
作者
Silvestri, G [1 ]
Pritchard, R
Welch, HG
机构
[1] Med Univ S Carolina, Div Pulm & Crit Care Med, Charleston, SC 29425 USA
[2] Dept Vet Affairs Med Ctr, Hematol Oncol Sect, White River Junction, VT 05009 USA
[3] Dept Vet Affairs Med Ctr, VA Outcomes Grp 111B, White River Junction, VT 05009 USA
关键词
D O I
10.1136/bmj.317.7161.771
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective: To determine how patients with lung cancer value the trade off between the survival benefit of chemotherapy and its toxicities. Design: Scripted interviews that included three hypothetical scenarios. Each scenario described the same patient with metastic non-small cell lung cancer with an expected survival of 4 months without treatment. Subjects were asked to indicate the minimum survival benefit required to accept the side effects of chemotherapy in the first two scenarios (mild toxicity and severe toxicity). In the third scenario, subjects were asked to choose between chemotherapy and supportive care when the benefit of chemotherapy was either to prolong life by 3 months or to palliate symptoms. Subjects: 81 patients previously treated with cis-platinum based chemotherapy for advanced non-small cell lung cancer. Main outcome measure: Survival threshold for accepting chemotherapy. Results: The minimum survival threshold for accepting the toxicity of chemotherapy varied widely in patients. Several patients would accept chemotherapy fur a survival benefit of 1 week, while others Many would not choose chemotherapy even for a survival benefit of 24 months. The median survival threshold for accepting chemotherapy was 4.5 months for mild toxicity and 9 months for severe toxicity. When given the choice between supportive care and chemotherapy only 18 (22%) patients chose chemotherapy for a survival benefit of 3 months; 55 (68%) patients chose chemotherapy if it substantially reduced symptoms without prolonging life. Conclusions: Patients' willingness to accept chemotherapy for the treatment of metastatic lung cancer varies widely Many would not choose chemotherapy for its likely survival benefit of 3 months but would if it improved quality of life. The conflict between these patients' preferences and the care they previously received has several explanations, one being that some patients had not received the treatment they would have chosen had they been fully informed.
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页码:771 / 775
页数:5
相关论文
共 16 条
[1]  
[Anonymous], 1988, CLIN CHEM
[2]   Trading treatment toxicity for survival in locally advanced non-small cell lung cancer [J].
Brundage, MD ;
Davidson, JR ;
Mackillop, WJ .
JOURNAL OF CLINICAL ONCOLOGY, 1997, 15 (01) :330-340
[3]  
GINSBERG RJ, 1993, CANC PRINCIPLES PRAC, P673
[4]   CHEMOTHERAPY FOR ADVANCED NON-SMALL-CELL LUNG-CANCER - HOW MUCH BENEFIT IS ENOUGH [J].
GRILLI, R ;
OXMAN, AD ;
JULIAN, JA .
JOURNAL OF CLINICAL ONCOLOGY, 1993, 11 (10) :1866-1872
[5]   INCORPORATING PATIENTS PREFERENCES INTO MEDICAL DECISIONS [J].
KASSIRER, JP .
NEW ENGLAND JOURNAL OF MEDICINE, 1994, 330 (26) :1895-1896
[6]   CHEMOTHERAPY VS SUPPORTIVE CARE IN ADVANCED NON-SMALL-CELL LUNG-CANCER - RESULTS OF A METAANALYSIS OF THE LITERATURE [J].
MARINO, P ;
PAMPALLONA, S ;
PREATONI, A ;
CANTONI, A ;
INVERNIZZI, F .
CHEST, 1994, 106 (03) :861-865
[7]   ON THE ELICITATION OF PREFERENCES FOR ALTERNATIVE THERAPIES [J].
MCNEIL, BJ ;
PAUKER, SG ;
SOX, HC ;
TVERSKY, A .
NEW ENGLAND JOURNAL OF MEDICINE, 1982, 306 (21) :1259-1262
[8]   PATIENT PREFERENCES FOR TREATMENT OF METASTATIC BREAST-CANCER - A STUDY OF WOMEN WITH EARLY-STAGE BREAST-CANCER [J].
MCQUELLON, RP ;
MUSS, HB ;
HOFFMAN, SL ;
RUSSELL, G ;
CRAVEN, B ;
YELLEN, SB .
JOURNAL OF CLINICAL ONCOLOGY, 1995, 13 (04) :858-868
[9]   METHODS FOR QUALITY ADJUSTMENT OF LIFE YEARS [J].
NORD, E .
SOCIAL SCIENCE & MEDICINE, 1992, 34 (05) :559-569
[10]   Cancer statistics, 1997 [J].
Parker, SL ;
Tong, T ;
Bolden, S ;
Wingo, PA .
CA-A CANCER JOURNAL FOR CLINICIANS, 1997, 47 (01) :5-27