Abstract
BackgroundIndividually tailored cancer treatment is essential to ensure optimal treatment and resource use. Treatments for incurable metastatic non-small cell lung cancer (NSCLC) are evolving rapidly, and decision support systems (DSS) for this patient population have been developed to balance benefits and harms for decision-making. The aim of this systematic review was to inventory DSS for stage IIIB/IV NSCLC patients.MethodsA systematic literature search was performed in Pubmed, Embase and the Cochrane Library. DSS were described extensively, including their predictors, model performances (i.e., discriminative ability and calibration), levels of validation and user friendliness.ResultsThe systematic search yielded 3531 articles. In total, 67 articles were included after additional reference tracking. The 39 identified DSS aim to predict overall survival and/or progression-free survival, but give no information about toxicity or cost-effectiveness. Various predictors were incorporated, such as performance status, serum and inflammatory markers, and patient and tumor characteristics. Some DSS were developed for the entire incurable NSCLC population, whereas others were specifically for patients with brain or spinal metastases. Few DSS had been validated externally using recent clinical data, and the discrimination and calibration were often poor.ConclusionsMany DSS have been developed for incurable NSCLC patients, but DSS are still lacking that are up-to-date with a good model performance, while covering the entire treatment spectrum. Future DSS should incorporate genetic and biological markers based on state-of-the-art evidence, and compare multiple treatment options to estimate survival, toxicity and cost-effectiveness.
Highlights
Tailored cancer treatment is essential to ensure optimal treatment and resource use
These decision support systems (DSS) aimed to predict prognosis (i.e., overall survival (OS) or progression-free survival (PFS)) in patients before or during treatments, such as systemic therapy (N = 6), RT, surgery and/or symptom management for brain metastases (N = 14) or for spinal metastases (N = 3), targeted therapies (N = 6), the general choice between tumor targeting vs. symptom management (N = 6), or mixed treatments (N = 4)
The 39 DSS included a multitude of predictors, of which performance status, age, extracranial metastases and serum albumin levels were the most frequently incorporated in DSS, whereas Epidermal growth factor receptor (EGFR) status was the only genetic marker
Summary
Tailored cancer treatment is essential to ensure optimal treatment and resource use. Treatments for incurable metastatic non-small cell lung cancer (NSCLC) are evolving rapidly, and decision support systems (DSS) for this patient population have been developed to balance benefits and harms for decision-making. The aim of this systematic review was to inventory DSS for stage IIIB/IV NSCLC patients. 80–85% of lung cancers are non-small cell lung cancer (NSCLC) [2]. The current treatment of incurable NSCLC patients consists of systemic chemotherapy (CT), radiotherapy (RT), therapies targeting oncodrivers (e.g., epidermal growth factor receptor tyrosine kinase inhibitors, EGFRTKI) or the immune system (immunotherapies), in addition to best supportive care (e.g., pain relief ). Mainly palliative surgery (for spinal metastases) and RT (for brain metastases) are advised. Palliative treatments aim to preserve or improve quality of life, lengthen life or decrease disease burden
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