Best Supportive Care

from Wikipedia, the free encyclopedia

The English term Best Supportive Care ( BSC ) stands in oncology for the best possible supportive treatment measures for cancer patients . This term is used very often in connection with clinical studies . An equivalent German-language expression that reflects the English-language term such as the best accompanying treatment , the best possible supportive care or the best possible symptomatic therapy or the best possible supportive therapy has not been able to establish itself so far.

definition

The European Organization for Research and Treatment of Cancer (EORTC) defines Best Supportive Care as follows:

"Supportive treatment measures for cancer patients include the multi-professional approach to the individual comprehensive physical, psychosocial, spiritual and cultural needs and should be available at all times of the illness for patients of all ages and regardless of the current treatment intention of the measures aimed at the disease."

The interpretation of this definition, however, leaves considerable room for maneuver, so that this definition is viewed by many authors as inadequate.

General aspects of Best Supportive Care are:

  • Improving the conditions for the feasibility of oncological therapies
  • Reduce the occurrence of undesirable side effects from potentially toxic therapies
  • Maintaining or increasing the patient's quality of life
  • Alleviate disease-related symptoms
  • Improve the prognosis of treatment outcomes

description

In clinical studies to test new drugs, the participants are in most cases divided into two groups: one group receives the new active substance to be tested, the other group does not. Instead of the active ingredient, the second group can receive a placebo , for example . In many oncological studies, both patient groups - one also speaks of the 'poor' in this context - also receive Best Supportive Care , that is, the best possible supportive care. The latter is particularly the case if the patients selected for the study are resistant to therapy (“out of therapy ”). The treatment then - mostly also in the arm that receives the active ingredient - no longer has a curative claim, but a palliative one .

In clinical studies with serious diseases, such as cancer or AIDS , it is fundamentally advisable for ethical reasons to provide both patient groups with the best known approved therapy (the “ gold standard ”). Best supportive care must be guaranteed for patients who have not been treated properly .

In bronchial carcinoma , for example, best supportive care is understood to mean all those measures: "which every doctor who cares for a patient has a basic command of and makes available to patients regardless of the stage of the disease and regardless of other therapies". In the broadest sense, Best Supportive Care is anything that helps people cope with their illness.

Best Supportive Care is usually defined at the start of a study . For example as: As measures for the best possible relief of symptoms and improvement of the quality of life. This should ensure the comparability of the results in both groups. On the other hand, since best supportive care can be defined differently in each study , problems can arise when comparing different studies. Best Supportive Care is neither precisely defined nor standardized. Even within a study, the comparability between the active ingredient and control group can be questioned if the study is not blinded and the active ingredient group comes into contact with medical staff more often than the control group, for example due to the application of the new active ingredient.

See also

Individual evidence

  1. a b S. Müller: data on survival time from two clinical studies with Erbitux in the treatment of metastatic colorectal cancer. Press release from Merck KGaA dated November 6, 2006.
  2. Supportive therapy is supportive therapy that alleviates the side effects of a necessary treatment.
  3. K. Schiemenz: Retrospective analysis of the therapy and the course of patients with brain metastases at the time of the initial diagnosis of non-small cell lung cancer. Dissertation, Medical Faculty Charité University Medicine Berlin, 2010.
  4. a b c A. S. Lübbe: On the way to a European standard for “best supportive care”.  ( Page no longer available , search in web archivesInfo: The link was automatically marked as defective. Please check the link according to the instructions and then remove this notice. In: In Focus Onkologie 1–2, 2003, pp. 50–55.@1@ 2Template: Toter Link / www.im-focus-onkologie.de  
  5. ^ A b S. Yousuf Zafar: Defining Best Supportive Care. In: Journal of Clinical Oncology 26, 2008, pp. 5139-5140, doi : 10.1200 / JCO.2008.19.7491 .
  6. ^ A b D. Garfield: Other Problems With Phase III Best Supportive Care Studies. In: Journal of Clinical Oncology 27, 2009, p. 829. doi : 10.1200 / JCO.2008.20.5237
  7. ^ A b B. Jack, A. Boland, R. Dickson, J. Stevenson, C. McLeod: Best supportive care in lung cancer trials is inadequately described: a systematic review. In: Eur J Cancer Care 19, 2010, pp. 293-301 PMID 19659663 (Review).
  8. NI Cherny et al .: Improving the methodologic and ethical validity of best supportive care studies in oncology: lessons from a systematic review. In: J Clin Oncol 27, 2009, pp. 5476-5486, PMID 19564538 .
  9. Supportive therapy in oncology is subject to constant further development and optimization. 14th Munich trade press workshop "Supportive therapy in oncology".
  10. M. Salzwimmer: Best Supportive Care for Patients with Head and Neck Cancer . In: WMW Wiener Medical Wochenschrift 158, 2008, pp. 278–282, doi : 10.1007 / s10354-008-0534-y , PMID 18560955 .
  11. M. Flicker: Bronchialkarzinom - Best Supportive Care.  ( Page no longer available , search in web archivesInfo: The link was automatically marked as defective. Please check the link according to the instructions and then remove this notice. In: Spectrum Oncology 03, 2007.@1@ 2Template: Dead Link / www.medmedia.at  
  12. ^ SY Zafar and AP Abernethy: In Reply. In: Journal of Clinical Oncology 27, 2009, p. 829, doi : 10.1200 / JCO.2008.20.6029 .

further reading

  • D. Casarett et al .: How should we design supportive cancer care? The patient's perspective. In: J Clin Oncol 26, 2008, pp. 1296-1301. PMID 18323553
  • K. Schoppmeyer and J. Mössner: Best supportive care of pancreatic carcinoma. In: Internist (Berl) 45, 2004, pp. 769-776. PMID 15160243 (Review)
  • HC Spangenberg among others: Best supportive care of hepatocellular carcinoma. In: Internist (Berl) 45, 2004, pp. 777-785. PMID 15160245 (Review)
  • C. Röder: Investigations into the quality of life of patients with bronchial carcinoma during chemotherapy. Dissertation, Martin Luther University Halle-Wittenberg, 2004
  • Y. Agra et al .: Chemotherapy versus best supportive care for extensive small cell lung cancer. In: Cochrane Database Syst Rev 4, 2003, CD001990. PMID 14583943 (Review)
  • O. Shajeem et al .: Chemotherapy versus best supportive care in the management of lung cancer. In: J Assoc Physicians India 51, 2003, pp. 261-264. PMID 12839347
  • CG Koedoot, RJ de Haan, AM Stiggelbout, PF Stalmeier, A. de Graeff, PJ Bakker, JC de Haes: Palliative chemotherapy or best supportive care? A prospective study explaining patients' treatment preference and choice. In: British Journal of Cancer . Volume 89, Number 12, December 2003, pp. 2219-2226, doi : 10.1038 / sj.bjc.6601445 , PMID 14676798 , PMC 2395270 (free full text).
  • L. Medley and M. Cullen: Best supportive care versus palliative chemotherapy in nonsmall-cell lung cancer. In: Curr Opin Oncol 14, 2002, pp. 384-388. PMID 12130920 (Review)
  • A. Anelli et al .: Chemotherapy versus best supportive care in stage IV non-small cell lung cancer, non metastatic to the brain. In: Rev Hosp Clin Fac Med Sao Paulo 56, 2001, pp. 53-58. PMID 11460205