患者对延迟疾病进展的态度和偏好在没有改善生存率的情况下
Michael D Brundage1, Christopher M Booth1, Elizabeth A Eisenhauer2
1Cancer Care and Epidemiology, Queen's University, Cancer Research Institute, Kingston, ON, Canada.
Journal of the National Cancer Institute
|July 17, 2023
概括
大多数癌症患者在没有整体生存 (OS) 益处的情况下,不优先考虑无进展生存 (PFS) 益处. 患者对癌症治疗的偏好在很大程度上取决于生活质量和生存优势.
科学领域:
- 在瘤学瘤学.
- 医疗决策的制定 医疗决策的制定
- 卫生经济学 卫生经济学
背景情况:
- 患者对癌症治疗的无进展生存 (PFS) 益处的看法,特别是没有整体生存 (OS) 益处的看法,尚未完全理解.
- 当前的研究往往忽略了影响治疗选择的细微患者价值,当仅扩展PFS时.
研究的目的:
- 确定患者愿意接受提供PFS增益但不提供OS增益的治疗.
- 将这些偏好与那些确实提供OS收益的治疗方法进行比较.
- 质量地探索患者治疗偏好的根本原因.
主要方法:
- 一个多中心,横截面,混合方法研究,涉及100名患有无法治愈的固体瘤的患者接受全身治疗.
- 使用治疗权衡练习来评估接受有毒性但没有OS优势的额外治疗所需的PFS收益.
- 采用定性主题分析和叙事方法来理解决策因素,并整合定量和定性数据.
主要成果:
- 显著的大多数 (51%) 患者会拒绝额外的毒性治疗,如果它没有提供OS优势,无论PFS的好处.
- 只有26%的患者会接受治疗,以获得3-9个月的PFS增长而没有改善OS,而17%的患者接受没有PFS益处.
- 相反,71%的人更喜欢提供6个月的OS优势的额外治疗,这突显了大多数患者的OS优于PFS的优势.
结论:
- 癌症患者普遍不重视延长进展时间的价值.
- 大多数患者不愿接受那些仅仅为了获得PFS而对生活质量产生负面影响的治疗.
- 这些发现对临床决策,医疗保健政策和瘤学临床试验的设计有影响.
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