Defining best supportive care: a systematic review of best supportive care in lung cancer trials

Jack, B. (2008) Defining best supportive care: a systematic review of best supportive care in lung cancer trials. Palliative Care Congress, 29 April - 1 May, Glasgow Royal Concert Hall, Glasgow.

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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

Item Type: Conference or Workshop Item (Poster)
Subjects: R Medicine > RT Nursing
Divisions: Nursing and Midwifery
Date Deposited: 03 Dec 2010 10:10
URI: http://repository.edgehill.ac.uk/id/eprint/1514

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