Certain forms of chemotherapy plus supportive care improve both survival and quality of life in patients with advanced gastrointestinal cancers compared to supportive care alone. Gastrointestinal cancer is the second most common form of cancer and is associated with a high mortality. There is some consistent evidence that patients with advanced gastrointestinal cancer benefit in both survival and quality of life by a combination of chemotherapy plus supportive care compared to receiving supportive care alone.
Overall the results show that for most of the studies included in this review, certain forms of chemotherapy plus supportive care improve both survival and quality of life in patients with gastrointestinal cancer (gastric and colorectal cancers) compared to receiving supportive care alone. Trials involving BSC/SC in patients with advanced gastrointestinal cancer require careful evaluation. Oncologists and researchers alike should strive for improvements in trial design and reporting. Future trials should focus on clearer definitions of supportive care. The EORTC definition of supportive care can be used as a guide. BSC/SC trials should use standardised validated outcome measures for symptom control, quality of life, toxicity and other useful palliative measures.
This review is an update of a previously published update review in The Cochrane Database of Systematic Reviews (Issue 4, 2006) on this topic. No new studies have been identified from the update search and the conclusions are not altered. Supportive care has traditionally been given to optimise the comfort of patients and their ability to function, as well as to minimise the side-effects of anti-cancer treatments. However, the scope of modern comprehensive supportive care is broadening and covers not only specific palliative treatment but non-tumour specific treatment such as social, psychological and spiritual support. In oncology, best supportive care (BSC) has been used as a comparator arm of randomised controlled trials in chemotherapy. However, the BSC arm is usually not well defined and its evaluation is therefore difficult because of the heterogeneity of the definitions. A systematic review was undertaken of the evidence from all RCTs of gastrointestinal cancers (includes gastrointestinal/gastric, colorectal/colon cancer but excludes pancreatic cancer trials) which include a BSC/SC arm.
1. To examine effectiveness/outcomes of best supportive care interventions versus cancer therapies for gastrointestinal cancer trials;
2. To determine whether trials containing best supportive care include a definition of this.
Electronic databases, grey literature sources, citation searching and reference checking, handsearches of journals and discussion with experts were used to identify potentially eligible trials from both published and unpublished sources up to July 2009.
RCTs comparing BSC/SC versus anticancer therapies in patients with gastrointestinal cancers.
Four RCTs were found and reviewed. Because of the heterogeneity of studies, a meta-analysis was not attempted. Data were extracted from the included studies and the quality of each was assessed.
Data from four studies (483 participants) were included. Due to the heterogeneity of studies (in terms of populations studied, the interventions used, the variety of outcomes and assessments used) it was not possible to make direct comparisons between the studies. The primary outcome in all four trials was survival, in spite of patients with advanced/metastatic gastrointestinal cancer having a poor prognosis, and the interventions being primarily palliative.