3.4.2 What is best supportive care for lung cancer patients? A systematic review of best supportive care in lung cancer trials (122)
Barbara Jack, Professor Of Nursing, Faculty of Health, Edge Hill University, Liverpool, United Kingdom Co authors: Angela Boland, Rumona Dickson, James Stevenson & Claire Mc Leod jackb@edgehill.ac.uk
Abstract:
Most research assessing the effectiveness of cancer treatments involves clinical trials where new treatments are compared with best supportive care. Generally, the term implies non-interventional care. However, in some instances, best supportive care may include active treatments (e.g. radiotherapy or chemotherapy). In England and Wales, the National Institute for Health and Clinical Excellence requires evidence of the clinical and cost effectiveness of new treatments before approval is awarded. It is therefore necessary for decision-makers to have access to the costs and benefits of best supportive care as currently employed in clinical trials.
Aims:
This research aims to identify whether or not best supportive care is adequately described in published reports of lung cancer trials.
Methods:
Systematic review of relevant studies identified through Medline, EMBASE, Science Citation Index and the Cochrane Library. Systematic reviews or randomised controlled trials were included if best supportive care was the comparator in lung cancer trials.
Results & discussion:
26 randomised controlled trials and 13 systematic reviews met the inclusion criteria. Less than 50% of studies included formal definitions of best supportive care. The included studies did not adequately describe the components or delivery of best supportive care. The best supportive care received by lung cancer patients is therefore unknown. Direct and indirect comparisons in trials comparing new treatments to best supportive care must be interpreted with caution as similar patients might have received substantially different packages of care.
Conclusions:
Definitions of best supportive care in the published literature are often inconsistent and at times non-existent. To improve NHS decision-making, health care professionals must recognise the importance of identifying, measuring and valuing the costs and benefits of best supportive care. Where definitions of best supportive care are inadequate, NHS decision-making becomes uninformed. This paper discusses these findings including the implications raised.
Source of Funding: N/A
Level of funding: N/A
Biography:
Professor Barbara Jack is an RGN, who completed her undergraduate studies at Swansea University and her postgraduate studies including her PhD at the University of Manchester. She was appointed as a senior lecturer in the Edge Hill University Faculty of Health in 1992 where she specialised in research methods. Following the completion of her PhD in 2001, “Evaluating the Impact of the Hospital Specialist Palliative Care Team”, she was seconded to the Marie Curie Palliative Care Institute Liverpool to undertake research in palliative care. This included evaluating the impact of the national End of Life initiative surrounding the Liverpool Care of the Dying Pathway. Her current research includes collaborative links with the Marie Curie Palliative Care Institute Liverpool on national projects including an action research project Modernising the Cancer Minimum Data Set. In 2006 Barbara established international research links with Hospice Africa Uganda and Edge Hill University and is currently evaluating the Impact of Nurses Prescribing Morphine and the Community Volunteer Programme.