title: Patient attitudes towards chemotherapy and survival: a prospective observational study in advanced non-small cell lung cancer.
abstract: This multicenter, non-interventional, prospective, observational study aimed to determine whether patients' attitude to chemotherapy is an independent prognostic factor for survival in patients with advanced non-small cell lung cancer (NSCLC) who are treated with gemcitabine-platinum. Chemonaive patients (n=1895) with stage IIIB or IV NSCLC not amenable to curative surgery or radiotherapy were treated with a combination of gemcitabine plus cisplatin/carboplatin and followed for a maximum of 18 months. Patients' attitude to treatment was measured on a 5-point scale and responses were used to assign patients to one of the three need categories: A, maximum extension of survival with the acceptance of high toxicity (60.0% of patients); B, maximum extension of survival only if coupled with normal lifestyle (26.1%); C, relief of symptoms (13.8%). Median survival varied significantly among the need categories (A=13.00 months, B=15.70 months, C=15.33 months; log-rank test P=0.0415). Patient attitude to treatment (need categories) was not a significant prognostic factor for survival after adjusting for known prognostic factors (P=0.0503). After adjusting for baseline differences, patients in this study had a significantly lower risk of death than patients in three randomized trials (hazard ratio 0.879; 95% confidence interval: 0.775, 0.998; P=0.0458). In conclusion, in this observational study, patient attitude to chemotherapy was not an independent prognostic factor of survival.
authors.affiliation: Cancer Institute & Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
authors.forename: Da-Tong
authors.initials: DT
authors.lastname: Chu
authors.forename: Sang-We
authors.initials: SW
authors.lastname: Kim
authors.forename: Hon-Ki
authors.initials: HK
authors.lastname: Hsu
authors.forename: Gürsel
authors.initials: G
authors.lastname: Cok
authors.forename: Jaromir
authors.initials: J
authors.lastname: Roubec
authors.forename: Shekhar
authors.initials: S
authors.lastname: Patil
authors.forename: Danail
authors.initials: D
authors.lastname: Damyanov
authors.forename: Teena
authors.initials: T
authors.lastname: West
authors.forename: Belinda
authors.initials: B
authors.lastname: Hall
authors.forename: Sedat
authors.initials: S
authors.lastname: Altug
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001294:Attitude to Health; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000401:mortality / Q000523:psychology*; D003841:Deoxycytidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D004358:Drug Therapy / Q000523:psychology; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000523:psychology*; D008297:Male; D019370:Observation; D010984:Platinum / Q000627:therapeutic use; D011446:Prospective Studies; D000093542:Gemcitabine
chemical_list: D000970:Antineoplastic Agents; D003841:Deoxycytidine; D010984:Platinum; D000093542:Gemcitabine