Implementation of Supportive Care and Best Supportive Care Interventions in Clinical Trials Enrolling Patients with Cancer
A partir d'une revue systématique de la littérature publiée entre 1980 et 2012 (73 études), cette étude analyse l'implémentation et la mise en oeuvre d'interventions en soins de support dans les essais cliniques incluant des patients atteints de cancer
Background : With the growing and evolving role of palliative care in oncology, we examined how supportive care (SC) and best supportive care (BSC) are implemented in clinical trials when used as a comparison treatment arm. Methods : We conducted a systematic review of the literature for clinical trials published between 1980–2012 in which systemic anticancer therapy was compared with a SC only arm and compared SC implementation to World Health Organization (WHO) published guidelines. Results : Our search identified 189 articles, 73 of which met our inclusion criteria with the following cancer types: 29 lung, 7 colorectal, 6 pancreatic, 5 gastric, and 26 other. Fifty-five studies (75%) provided some definition of SC, and 48 studies (66%) used the term BSC. Twenty-one of the 55 studies that provided a definition described the use of palliative therapies as being “at the discretion of the treating physician” without standardization. Only two studies provided SC that incorporated routine physical, psychological and social assessments including rapid referral to supportive care specialists. SC interventions most commonly included analgesics (47%) and radiotherapy (44%). Trials using the term BSC versus SC were more likely to include blood transfusions (p=0.002) and antibiotics (p=0.033), but less likely to include steroids (p=0.05) and palliative specialists (p=0.047). Conclusions : The implementation of SC in clinical trials in this systematic review is highly variable. The vast majority of the studies did not meet the WHO guidelines on SC because palliative care therapies were not recommended or integrated into care. Future clinical trials utilizing a SC intervention arm should define these interventions in a standardized approach that meets current guidelines such as the WHO recommendations.