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Supportive care for patients with gastrointestinal cancer

  • Review
  • Intervention

Authors

  • Nisar Ahmed,

    Corresponding author
    1. University of Sheffield, Academic Unit of Supportive Care, School of Medicine and Biomedical Sciences, Sheffield, South Yorkshire, UK
    • Nisar Ahmed, Academic Unit of Supportive Care, School of Medicine and Biomedical Sciences, University of Sheffield, Sykes House, Little Common Lane, Sheffield, South Yorkshire, S11 9NE, UK. n.ahmed@sheffield.ac.uk.

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  • Sam Ahmedzai,

    1. University of Sheffield, Academic Unit of Supportive Care, School of Medicine and Biomedical Sciences, Sheffield, South Yorkshire, UK
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  • Vandana Vora,

    1. St Luke's Hospice and Royal Hallamshire Hospital, Medicine and Clinical Governance, Sheffield, South Yorkshire, UK
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  • Sophie Harrison,

    1. University Hospital South Manchester, Wythenshawe Hospital, Manchester, UK
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  • Silvia Paz

    1. Institut Catalá d'Oncologia, WHO Collaborating Centre for Public Health Palliative Care Programme, Barcelona, Spain
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Abstract

Background

This review is an update of a previously published update review in The Cochrane Database of Systematic Reviews (Issue 4, 2006) on this topic. No new studies have been identified from the update search and the conclusions are not altered. Supportive care has traditionally been given to optimise the comfort of patients and their ability to function, as well as to minimise the side-effects of anti-cancer treatments. However, the scope of modern comprehensive supportive care is broadening and covers not only specific palliative treatment but non-tumour specific treatment such as social, psychological and spiritual support. In oncology, best supportive care (BSC) has been used as a comparator arm of randomised controlled trials in chemotherapy. However, the BSC arm is usually not well defined and its evaluation is therefore difficult because of the heterogeneity of the definitions. A systematic review was undertaken of the evidence from all RCTs of gastrointestinal cancers (includes gastrointestinal/gastric, colorectal/colon cancer but excludes pancreatic cancer trials) which include a BSC/SC arm.

Objectives

1. To examine effectiveness/outcomes of best supportive care interventions versus cancer therapies for gastrointestinal cancer trials;
2. To determine whether trials containing best supportive care include a definition of this.

Search methods

Electronic databases, grey literature sources, citation searching and reference checking, handsearches of journals and discussion with experts were used to identify potentially eligible trials from both published and unpublished sources up to July 2009.

Selection criteria

RCTs comparing BSC/SC versus anticancer therapies in patients with gastrointestinal cancers.

Data collection and analysis

Four RCTs were found and reviewed. Because of the heterogeneity of studies, a meta-analysis was not attempted. Data were extracted from the included studies and the quality of each was assessed.

Main results

Data from four studies (483 participants) were included. Due to the heterogeneity of studies (in terms of populations studied, the interventions used, the variety of outcomes and assessments used) it was not possible to make direct comparisons between the studies. The primary outcome in all four trials was survival, in spite of patients with advanced/metastatic gastrointestinal cancer having a poor prognosis, and the interventions being primarily palliative.

Authors' conclusions

Overall the results show that for most of the studies included in this review, certain forms of chemotherapy plus supportive care improve both survival and quality of life in patients with gastrointestinal cancer (gastric and colorectal cancers) compared to receiving supportive care alone. Trials involving BSC/SC in patients with advanced gastrointestinal cancer require careful evaluation. Oncologists and researchers alike should strive for improvements in trial design and reporting. Future trials should focus on clearer definitions of supportive care. The EORTC definition of supportive care can be used as a guide. BSC/SC trials should use standardised validated outcome measures for symptom control, quality of life, toxicity and other useful palliative measures.

摘要

背景

腸胃道癌症病人的支持性療法

支持性療法傳統上是用於優化病人舒適, 活動能力及降低抗癌症治療之副作用. 然而現代全方位的支持性療法領域更為廣泛, 不只是包含特定的姑息治療, 也包括非腫瘤方面, 例如社會的, 心理的和靈性的支持. 在腫瘤學的領域, 最佳的支持性療法(best supportive care (BSC))常用於在隨機, 對照組控制試驗中與化學治療做比較. 然而, 因為定義的異質性, 最佳的支持性療法無法被精確定義及評估. 本系統性的評估正試圖挑選從所有對於腸胃道癌症(包括腸胃道/胃, 大腸直腸/大腸癌, 但排除胰臟癌之試驗)的隨機, 對照組控制試驗中包含以最佳支持性療法BSC/支持性療法SC作為比較組的研究. 本文將過去發表在The Cochrane Database of Systematic Reviews (Issue 1, 2005)加以更新. 其中並無新的試驗可以被搜尋到, 並且結論並沒有被變更.

目標

1. 比較腸胃道癌症試驗中最佳支持性療法和腸胃道腫瘤治療的效果及結果2. 決定試驗是否對最佳支持性療法有作定義.

搜尋策略

從Electronic databases, grey literature sources, citation searching中收尋相關之參考文獻和經由與專家討論, 從發表及未發表的文章中尋找出符合條件的試驗.

選擇標準

比較針對胃腸癌最佳支持性療法/支持性療法和抗腫瘤治療作比較的隨機, 對照組控制試驗.

資料收集與分析

尋找到4個隨機, 對照組控制試驗並檢視之. 因為這些研究的差異性, 統合分析並不能實行. 統計資料從這些論文中擷取出, 而這些研究的品質也被評估.

主要結論

從這4個包含483個病患的試驗中得到統計數據. 因為這些研究的差異(包含族群, 介入方法的使用, 結果的差異), 直接比較各個研究間的差異是不可能的. 儘管末期或轉移性腸胃腫瘤病患有較差的預後且以緩解性的治療做為評估的的方法,這四個試驗所要觀察的主要結果是存活率.

作者結論

綜觀所有的結果, 本文中包括的多數試驗顯示腸胃道腫瘤(胃及大腸直腸癌)病人中,接受化療合併支持性照護比單獨接受支持療護, 能改善存活率和生活品質. 腸胃道腫瘤病患接受BSC/SC之試驗需要仔細評估. 腫瘤科醫師及研究者應努力改善這些試驗的設計. 未來的研究應著重支持性照護的明確定義. EORTC對於支持性照護的定義可以作為指引. BSC/SC試驗應利用標準且有效力的方法來評估症狀控制, 生活品質, 毒性及其他有效的治療方案.

翻譯人

本摘要由三軍總醫院蔡維哲翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

某些形式的化學治療合併支持性照護, 在末期腸胃道腫瘤的病人中, 相較於單獨的支持性照護, 可以改善存活率及生活品質. 腸胃道腫瘤是第二常見的腫瘤且有高死亡率. 有些一致的證據顯示末期腸胃道腫瘤的病人, 相較於單獨接受支持性照護, 合併化學治療及支持性照護對於存活率及生活品質是有利的

Plain language summary

Supportive care for patients with gastrointestinal cancer

Certain forms of chemotherapy plus supportive care improve both survival and quality of life in patients with advanced gastrointestinal cancers compared to supportive care alone. Gastrointestinal cancer is the second most common form of cancer and is associated with a high mortality. There is some consistent evidence that patients with advanced gastrointestinal cancer benefit in both survival and quality of life by a combination of chemotherapy plus supportive care compared to receiving supportive care alone.

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