Palliative chemotherapy of non small lung cancer in Tunisia. Prospective study of the cost and impact on the quality of life.
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Abstract
Background: Bronchopulmonary cancer is actually the first cancer in the world. In Tunisia, recent statistics are alarmous. The most bronchopulmonary cancer in tunisian series are diagnosis at metastatic states.
Aim : To evaluate the cost of the global treatment by chemotherapy in patients with metastatic non small lung cancer and its impact over the quality of life in Tunisia.
Methods : It’s a prospective study lead between January 2006 and Juin 2007 to evaluate the quality of life for patients hading metastatic non small lung cancer treated by palliative chemotherapy in Ibn Nafiss department in Abderrahmen Mami hospital.The evaluation of the qualitt of life is inspired by the questionnary of EORTC : QLQC30 version 3 translated in en arab langage, filled before chemotherapy, after the le 3rdcycle, and at the end of the first ligne.
The study of the cost is effectued for the 2 protocols whose the most used in first ligne : Cisplatin-Vinorelbine (P-V) and Cisplatin- Gemcitabine (P-G)
Results : 30 patients had benefit from palliative chemotherapy based on P-V (18 cases) or P-G (12 cases). All patients had responded for the questionnary in the opportunt moments. After 3 cycles of chemotherapy, we note an improve of the symtomatic, physical, activity, emotional and global health scales. In opposition, we note a deterioration of cognitive and social scales without any supplementary improvement(no significant difference) if we add other cycles in the twice protocols. At the same level of the benefit in term of quality of life and survival without supplementary toxicity, the choice is made by the less cost’s protocol in other words P-V.
Conclusion : Our results confirm the benefit from chemotherapy in term of survival and quality of life in our context, howewer, the important cost of the chemotherapy necessitate to rationnalize the indications and the le choice of the treatments in this palliative indication.
Keywords:
Tumour, lung, chemotherapy, quality of life, economic analysis##plugins.themes.academic_pro.article.details##
References
- Registre des cancers Nord Tunisie. Données 1999-2003, Evolution 1994-2003, Projections à l'horizon 2024.Ministère de la santé publique.
- Hsairi M, Fakhfakh R, Ben Abdallah M , Jelidi R, Sellami A, Nacef T. Assessment of cancer in Tunisia 1993-1997.Tunis Med 2002 ; 80 : 57-64
- El Mezni F, Mrabet N, Ismaïl O.Pathological profile of lung carcinoma in Tunisia. About 869 cases.Tunis Med. 2005;83:157- 62
- Fajraoui N, Charfi MR, Khouini H, Annabi H, Bouhaouala MH, Boussen MH.Clinical epidemiology of primary lung cancer in Tunisia .100 cases. Tunis Med 2007; 85: 766-72
- Therasse P, Arbuck SG, Eisenhauer EA et al. New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J. Natl. Cancer Inst. 2000; 92: 205-216.
- Aaronson NK,Ahmedezal S,Bergman B et al.The European Organization for Research and Treatment of cancer QLQ-C30 :A quality of life instrument for use in international clinical trials in oncology.J Natl Cancer Inst 1993;85:365-76
- Fenniche S, Chabbou A, Attia S,Bousnina S, Marniche K, Megdiche M. L. Questionnaire de mesure de la qualité de vie en oncologie thoracique chez le patient tunisien. Tunis Med. 2005;83(Supp 11):67
- Le Chevalier T, Scagliotti G, Natale R et al. Efficacy of gemcitabine plus platinum chemotherapy compared with other platinum containing regimens in advanced non-small-cell lung cancer: a meta-analysis of survival outcomes. Lung Cancer. 2005; 47:69-80
- Chouaid C, Atsou K, Hejblum G, Vergnenegre A. Economics of treatments for non-small cell lung cancer. Pharmacoeconomics. 2009;27:113-25.
- Vergnenègre A, Atsou K, Molinier L, Chouaïd C. Les analyses économiques des cancers bronchopulmonaires (CBP). Rev Mal Respir 2008 ; 25 :3S127-37
- Vergnenègre A. Stage IV non-small cell lung cancer. CBNPC stade IV Durée optimale de la chimiothérapie initiale des cancers non à petites cellules localement avancés. Rev Mal Respir. 2006;23:72-77.
- Pérol M. Traitement de première ligne des cancers bronchiques non à petites cellules métastatiques. Rev Pneumol Clin 2004 ;60 : 51-56.
- Molinier L, Combescure C, Chouaïd C et al. Cost of lung cancer: a methodological review. Pharmacoeconomics. 2006;24:651-9
- Vergnenègre A. Cost-effectiveness analysis: a readers' guide. Rev Mal Respir. 2004 Sep; 21:S47-55