Abstract
Background: 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
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 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 and 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, all nursing and medical
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 will discuss these findings including the ethical
implications it raises.Palliative M
Original language | English |
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Publication status | Published - 2008 |
Event | Palliative Care Congress - Glasgow Royal Concert Hall, Glasgow, United Kingdom Duration: 29 Apr 2008 → 1 May 2008 |
Conference
Conference | Palliative Care Congress |
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Country/Territory | United Kingdom |
City | Glasgow |
Period | 29/04/08 → 1/05/08 |