Diego Candelmi, Alazne Belar, Carla Zapata Del Mar, Ana Landa-Magdalena, Anna Vilalta-Lacarra, Mariano Ponz-Sarvisé, Carlos Centeno
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引用次数: 0
Abstract
Background: Phase 1 cancer clinical trials offer potential disease modifying treatments for patients with advanced cancer who have not responded to standard treatments. These patients also experience palliative care needs that should be addressed. However, misunderstandings may arise between the goals of experimental treatments and the goals of palliative care, especially when the latter focuses on quality of life.
Aim: This study aimed to map the existing literature on the provision and integration of palliative care within phase 1 clinical trials, identifying knowledge gaps and informing future research.
Design: A systematic scoping review.
Data sources: Studies published from 2003 to 2023 were identified through searches in PubMed, Web of Science, Scopus, CINAHL, PsycINFO and Google Scholar, focussing on people living with advanced cancer enrolled in phase 1 clinical trials.
Results: Fifty studies were included from 452 screened. Key results revealed patients' limited life expectancy, high symptom burden, distress and unmet spiritual needs. Notably, patients were reluctant to seek prognostic information or engage in end-of-life discussions, complicating advance care planning. End-of-life care involved frequent unscheduled hospital admissions, hospital deaths and late hospice-care referrals. Caregivers experienced significant distress, while healthcare professionals faced barriers to integrating palliative care. Palliative care interventions varied widely in approaches, settings and outcomes.
Conclusion: This review highlights the unique needs of patients and caregivers in Phase 1 Cancer Clinical Trials and the complexities of integrating palliative care. Future research should focus on integrating specialised palliative care into oncology trials and developing standardised guidelines for clinical trial units.
背景：1期癌症临床试验为标准治疗无效的晚期癌症患者提供了潜在的疾病改善治疗。这些患者还经历了应该解决的姑息治疗需求。然而，在实验性治疗的目标和姑息治疗的目标之间可能会产生误解，特别是当后者侧重于生活质量时。目的：本研究旨在对现有的一期临床试验中提供和整合姑息治疗的文献进行梳理，找出知识空白，为未来的研究提供信息。设计：系统的范围审查。数据来源：2003年至2023年发表的研究通过PubMed、Web of Science、Scopus、CINAHL、PsycINFO和谷歌Scholar等网站的搜索确定，主要集中在1期临床试验的晚期癌症患者。结果：从筛选的452项研究中纳入了50项研究。主要结果显示患者预期寿命有限，症状负担高，痛苦，精神需求未得到满足。值得注意的是，患者不愿意寻求预后信息或参与临终讨论，使预先护理计划复杂化。临终关怀包括频繁的计划外住院、住院死亡和晚期临终关怀转介。护理人员经历了巨大的痛苦，而医疗保健专业人员面临着整合姑息治疗的障碍。姑息治疗干预措施在方法、环境和结果方面差别很大。结论：本综述强调了i期癌症临床试验患者和护理人员的独特需求以及整合姑息治疗的复杂性。未来的研究应侧重于将专门的姑息治疗纳入肿瘤试验，并为临床试验单位制定标准化的指南。
期刊介绍：
Palliative Medicine is a highly ranked, peer reviewed scholarly journal dedicated to improving knowledge and clinical practice in the palliative care of patients with far advanced disease. This outstanding journal features editorials, original papers, review articles, case reports, correspondence and book reviews. Essential reading for all members of the palliative care team. This journal is a member of the Committee on Publication Ethics (COPE).
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