Best supportive care in lung cancer trials is inadequately described: a systematic review

Abstract

JACK B., BOLAND A., DICKSON R., STEVENSON J. & MCLEOD C. (2010) European Journal of Cancer Care19, 293–301 Best supportive care in lung cancer trials is inadequately described: a systematic review The objective of the paper was to identify and discuss clinical terms associated with the availability and delivery of best supportive care for patients with lung cancer in randomised controlled clinical trials. Systematic review was carried out of relevant studies without language restrictions identified through Medline, EMBASE, Science Citation Index (Web of Science and ISI Proceedings) and Cochrane Library. Reference lists of retrieved articles were also searched to identify further studies. Articles describing randomised controlled trials or systematic reviews with a comparator arm of best supportive care for patients with lung cancer were studied. Definitions of best supportive care and elements of best supportive care were reported. Included clinical studies (n = 40) did not adequately describe or outline either the components or the delivery of best supportive care for patients in lung cancer trials. None of the identified studies provided a clear definition of a patient pathway in relation to best supportive care, or a clear list of components. Clinical studies are being conducted without a clear definition of the best supportive care provided in the comparator arms of trials. Inadequate definitions mean that all direct and indirect comparisons in trials comparing active treatments with best supportive care must be interpreted with caution.

Survival among non-small cell lung cancer patients with poor performance status after first line chemotherapy

“…These treatments could be expensive and increase end of life care costs, or actually reduce symptom burden and increase survival, so this issue will be at the forefront of rational resource allocation [23]. Given the prevalence of poor PS in community cohorts (34% classified as PS 2–4 by physicians, 48% self-classified as PS 2–4 [24], and one third with database-derived poor PS [14]) and the limited number of trials enrolling poor PS patients, research is needed to confirm these findings in a larger and more diverse sample or in a randomized controlled trial where the only difference is receipt of chemotherapy, and all patients are offered reasonable and defined best supportive care [25]. The evaluation of treatment of poor performance patients will become especially important with the availability of costly targeted drugs that have fewer toxicities and some benefit.…”

Erlotinib or best supportive care for third-line treatment of advanced non-small-cell lung cancer: A real-world cost-effectiveness analysis

“…As mentioned previously, BSC is not a well-characterized treatment method [6]. Our methods were able to capture all health-care system resource utilization in our BSC population.…”

“…There is no conventional standardized definition of what makes up BSC [6], so it was defined in this study as all treatment received within the health care system from end of second-line treatment to death or censoring. Patients in the treatment group received erlotinib according to BCCA protocols: erlotinib 150 mg orally daily is continued until evidence of disease progression at which time erlotinib is discontinued [5].…”

Cost-Effectiveness of Maintenance Pemetrexed in Patients with Advanced Nonsquamous-Cell Lung Cancer from the Perspective of the Swiss Health Care System

“…In a second analysis, the value for BSC cost per unit of time was reduced by a factor of 10, to illustrate the potential impact of low BSC costs as described in a health technology assessment report for the United Kingdom by Greenhalgh et al [33]. This wide range reflects a knowledge gap with respect to the cost of BSC [34]. A multiplier for the BSC cost per unit of time in the pemetrexed arm vs. the BSC arm was included to cover the possibility of differences in BSC-related resource use between strategies.…”