がん患者の予後予測と,治療の好みの関係
J C Weeks1, E F Cook, S J O'Day
1Department of Adult Oncology, Dana-Farber Cancer Institute, Boston, MA 02115-6084, USA. janevweeks@dci.harvard.edu
JAMA
|June 12, 1998
まとめ
末期がん患者はしばしば生存率を過大評価し,治療選択に影響を与えます. 正確な予後を理解することは,寿命を延ばす治療よりも快適なケアを好むことと関連しています.
科学分野:
- 腫瘍学 腫瘍学
- 緩和ケアとは,緩和ケアです.
- 医療上の意思決定をする.
背景:
- がん患者はしばしば,長期的な生存確率を過大評価する.
- 誤った予後認識は,患者の価値観と整合していない治療の選択につながる可能性があります.
- この研究は,末期がん患者における正確な予後と治療の好みとの関連を調査しています.
研究 の 目的:
- 末期がん患者において,生命を延長する治療法よりも快適性に焦点を当てた治療法を好むことと,正確な予後理解が相関するかどうかをテストする.
主な方法:
- ステージIII/IVの転移性非小細胞肺がんや結腸がんを患っている917人の成人患者を対象とした前向きなコホート研究.
- 5つのアメリカの大学院病院から収集されたデータです.
- 患者/医師の生存率の推定値と実際の6ヶ月生存率を比較し,生命の延長と快適なケアに対する優先順位を評価した.
主要な成果:
- 6ヶ月の生存率を過大評価した患者は,寿命を延ばす治療を好む可能性が高くなった (OR2.6).
- この好みは,患者の生存推定値が非常に高い (>90%) と医師の推定値が非常に低い (<=10%) のときで最も顕著でした.
- 医師は予後を正確に推定し,患者は一貫して生存の可能性を過大評価した.
結論:
- 転移性肺癌や結腸癌の患者は,生存確率を過大評価している.
- これらの膨張された生存推定値は,医療療法に関する患者の好みに著しく影響を与えます.
- 過大評価による寿命を延ばす治療の好みは,実際の6ヶ月生存率を改善しませんでした.
関連する概念動画
02:56Treatment Resistant Cancers
Cancer is the second leading cause of death in the United States. A cancer cell is genetically unstable and hence can mutate faster. They can also modify their microenvironment and escape immune surveillance. The difficulties in treating cancer are further compounded by the emergence of rapid resistance to anticancer drugs. The most common ways to attain resistance in cancer cells include alteration in drug transport and metabolism, modification of drug target, elevated DNA damage response, or...
02:50Combination Therapies and Personalized Medicine
Combining two or more treatment methods increases the life span of cancer patients while reducing damage to vital organs or tissue from the overuse of a single treatment. Combination therapy also targets different cancer-inducing pathways, thus reducing the chances of developing resistance to treatment.
The combination of the drug acetazolamide and sulforaphane is a good example of combination therapy to treat cancer. The cells in the interior of a large tumor often die due to the hypoxic and...
The combination of the drug acetazolamide and sulforaphane is a good example of combination therapy to treat cancer. The cells in the interior of a large tumor often die due to the hypoxic and...
02:56Treatment Resistent Cancers
Cancer is the second leading cause of death in the United States. A cancer cell is genetically unstable and hence can mutate faster. They can also modify their microenvironment and escape immune surveillance. The difficulties in treating cancer are further compounded by the emergence of rapid resistance to anticancer drugs. The most common ways to attain resistance in cancer cells include alteration in drug transport and metabolism, modification of drug target, elevated DNA damage response, or...
01:27Nursing Ethical Principles II
Ethical principles are essential in guiding nurses to fulfill their responsibilities, focusing on the quality of nursing care and decision-making. These principles, including autonomy, beneficence, non-maleficence, justice, and fidelity, shape the ethical framework within healthcare settings.
Consider the following scenario, which illustrates how these principles are applied in the care of Mr. John, a fifty-year-old teacher diagnosed with metastatic liver cancer.
Initially, Mr. John's cancer...
Consider the following scenario, which illustrates how these principles are applied in the care of Mr. John, a fifty-year-old teacher diagnosed with metastatic liver cancer.
Initially, Mr. John's cancer...
01:30Cancer Vaccines
Cancer treatment vaccines are a rapidly evolving field that offers a promising approach to immunotherapy. Unlike traditional vaccines that prevent diseases, cancer treatment vaccines are designed to treat existing cancers by stimulating the immune system to recognize and attack cancer cells.
Cancer vaccines come in two categories: preventive (prophylactic) and treatment (active). Preventive vaccines, such as the Human Papillomavirus (HPV) vaccine, protect against viruses that cause certain...
Cancer vaccines come in two categories: preventive (prophylactic) and treatment (active). Preventive vaccines, such as the Human Papillomavirus (HPV) vaccine, protect against viruses that cause certain...
01:21Cancer Survival Analysis
Cancer survival analysis focuses on quantifying and interpreting the time from a key starting point, such as diagnosis or the initiation of treatment, to a specific endpoint, such as remission or death. This analysis provides critical insights into treatment effectiveness and factors that influence patient outcomes, helping to shape clinical decisions and guide prognostic evaluations. A cornerstone of oncology research, survival analysis tackles the challenges of skewed, non-normally...