肺非小細胞癌：早期緩和ケアはＱＯＬ、気分改善だけでなく、生存率を改善

早期緩和ケア導入にて、肺非小細胞癌において、有意に、ＱＯＬ、情緒改善をもたらし、積極的ケアを行うことが少なく、生存率の改善をもたらした。

Early Palliative Care for Patients with Metastatic Non–Small-Cell Lung Cancer

Jennifer S. Temel, M.D., Joseph A. Greer, Ph.D., Alona Muzikansky, M.A., Emily R. Gallagher, R.N., Sonal Admane, M.B., B.S., M.P.H., Vicki A. Jackson, M.D., M.P.H., Constance M. Dahlin, A.P.N., Craig D. Blinderman, M.D., Juliet Jacobsen, M.D., William F. Pirl, M.D., M.P.H., J. Andrew Billings, M.D. and Thomas J. Lynch, M.D.

N Engl J Med 2010; 363:733-742August 19, 2010

プロトコール：http://www.nejm.org/doi/suppl/10.1056/NEJMoa1000678/suppl_file/nejmoa1000678_protocol.pdf

プライマリエンドポイント指標

Functional Assessment of Cancer Therapy–Lung (FACT-L) scale
Hospital Anxiety and Depression Scale

生存率：http://www.nejm.org/doi/full/10.1056/NEJMoa1000678
（直接図表リンク対策されたようだ・・・）

治療を全面的に否定するような解釈もされそうだが、ベースラインでもプラチナ製剤・ＥＧＦＲチロシンキナーゼ阻害剤、放射線治療など治療背景に差はない。


十分読みこなすに値する論文と思われ、今後加筆予定

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5.3.1. Palliative Care Intervention
Palliative care is comprehensive, coordinated interdisciplinary care for patients and families facing a potentially life-threatening illness.
The Palliative Care Services (PCS) at DF/PCC consists of specially trained teams of professionals that provide care and support in inpatient and outpatient settings.
The PCS is comprised of physicians, nurses, social workers, chaplains, bereavement specials, and volunteers.
While the specific assistance and support provided by the PCS depends on individual patient and family needs and preferences, it may include:
1. pain and symptom management,
2. psychosocial and spiritual support,
3. assistance with treatment choices,
4. help in planning for care in the community, and
5. bereavement support and referral.


5.3.1.1. Integrated Palliative Care Intervention
Patients in the integrated palliative care arm of the study will be required to meet with the PCT within three weeks of enrolling in the study.
An attending physician/nurse practitioner from the PCT will perform the initial assessment.
We have developed general guidelines to ensure a uniform and reproducible intervention between the participating hospitals and palliative care providers.
The clinicians will use the included guidelines – Palliative Care Intervention (Appendix A) as a tool to provide comprehensive symptom management and psychosocial, spiritual, and emotional support to patients and their families.
We will also require the palliative care to document how much of the visit was spent on each element of the intervention guideline.