Patienteneinstellung gegenüber der Chemotherapie und deren Nebenwirkungen als einer der Prognosefaktoren für das Überleben beim nicht-kleinzelligen Bronchialkarzinom.
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Philipps-Universität Marburg
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Abstract
Background
Cancer in advanced stages represents one of the biggest challenges for medicine in achieving the best possible treatment results regarding patients' expectations. Several fac- tors may influence the treatment. One is the patients' cooperation (compliance and adherence), whereas the declarative attitude towards therapy has been rarely investigated. This study aimed to investigate how the attitude towards chemotherapy and its side effects looks like and whether this attitude can be seen as a prognostic factor for survival.
Methods
There were analyzed data from a completed randomized Phase III trial in non-small cell lung cancer "sequential Mono vs. dual vs. triple combination therapy". A total of 272 patients with NSCLC in tumor stage IIIB or IV aged between 34-75 from 24 clinics in Germany were analyzed. The patients should fulfill before and after the treatment a ques- tionnaire on attitude towards chemotherapy. There were ten examples of chemotherapy side effects, and the patients were asked about their acceptance according to their poten- tial benefit. The patients had to keep a diary during the treatment, where the toxicity symptoms, according to NCI-CTC, and laboratory test results of the study participants were recorded. Furthermore, there was a quality of life questioner, according to EORTC, fulfilled.
Results
The vast majority of the patients were ready to endure the side effects of chemotherapy. The biggest concerns presented here vomiting, rashes, and numbness of the limbs. The acceptance increased with the potential profit of the therapy. However, it was observed that those who were not accepting these side effects had a longer OS; the longer, the higher the grade of potential treatment benefit rejection. This trend was seen in all exam- ples of the side effects. It was statistically relevant (Log-rank p=0,027) in the question concerning the attitude towards blood transfusion, where the OS was 1,5 higher in those who rejected blood transfusion even if its acceptance hypothetically led to 1-year life prolongation (12,5 vs. 8 months). Additionally, it was observed that behind the known factors as the Karnofsky Index or the presence of metastasis also transfusion during the first cycle might be seen as a statistically relevant unfavorable survival predictive factor (Log-rank p=005)
Discussion
In the study, the most important aspect for the patients was life prolongation even if as- sociated with more side effects. However, the negative attitude towards side effects of the treatment, especially blood transfusion, was surprisingly a favorable prognostic factor for survival. An explanation of this trend remains hidden, but it may indicate that psychologic attitude plays an underestimated role in therapy success. Furthermore, in the study, blood transfusion during the first cycle of chemotherapy might be rated as a negative prognostic factor. To answer the question, if these observations are clinically relevant further studies on these issues are needed.
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Dates
Created: 2021Issued: 2021-08-09Updated: 2021-08-09
Faculty
Medizin
Publisher
Philipps-Universität Marburg
Language
ger
Data types
DoctoralThesis
Keywords
prognostic factors for survival in non-small cell lung cancerPatients attitude towards chemotherapyPrognosefaktoren für das Überleben beim nicht-kleinzelligenPatienteneinstellung gegenüber der Chemotherapie
DFG-subjects
PrognoseTherapie, BluttransfusionNebenwirkungChemotherapieÜberlebenFragebogenLungenkrebsBronchialkrebsEinstellung
DDC-Numbers
610
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Marczewski, Tadeusz: Patienteneinstellung gegenüber der Chemotherapie und deren Nebenwirkungen als einer der Prognosefaktoren für das Überleben beim nicht-kleinzelligen Bronchialkarzinom.. : Philipps-Universität Marburg 2021-08-09. DOI: https://doi.org/10.17192/z2021.0298.
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This item has been published with the following license: In Copyright