Table 32Summary of applicability of evidence for Key Question 3

DomainApplicability of Evidence
Populations
  • The patients in the studies included in this report appear representative of cases that would be considered for a bronchoscopic intervention. All patients included in the 6 studies had histologically confirmed NSCLC with airway obstruction that required a bronchoscopic intervention. The mean age of patients included in these studies ranged from 61–68 years and this is congruent with the incidence of NSCLC that tends to rise with age.
Interventions
  • The single modality interventions (brachytherapy, EBRT, electrocautery, laser, photodynamic, debridement, stenting) and 2 dual modality interventions (laser plus brachytherapy and brachytherapy plus EBRT) represent a general landscape of current treatments options for patients with endoluminal obstructive NSCLC and therefore are applicable.
Comparators
  • See above for Intervention
Outcomes
  • The major outcomes of interest were symptom relief, overall survival, disease specific survival, quality of life and treatment-related toxicity.
  • Although OS is the primary direct outcome for any cancer intervention study, it may not be the best measure of efficacy of a palliative intervention in symptomatic patients. Immediate relief of obstructive symptom and improvement in quality of life provide reasonable and pertinent justification for use of endobronchial intervention in such patients.
  • According to the structured review by the Patient Reported Outcome Measurement Group-Oxford on the use of PROMs (Patient Reported Outcomes Measures),106 both generic and disease specific instruments exists that can be used in patients with lung cancer to assess the impact of interventions on QOL. These measures include generic measures such as SF-36 and EQ-5D and lung cancer specific measures such as EORTC QLQ-C30, EORTC QLQ-LC13 and FACT-L. However, QOL data was reported only by one small study of the six comparative studies. Therefore, applicability of the current evidence base on QOL cannot be determined.
Timing
  • The relevant periods occur at the time of treatment through followup over months (palliation) or years (overall survival).
Setting
  • The outcomes of local bronchoscopic therapies largely depend on the expertise of the provider and the center providing these services. We could not assess the impact of such operating characteristics on the treatment outcomes because these data were not available in the published papers.

EBRT = external-beam radiotherapy; EORTC QLQ = European Organization for Research and Treatment of Cancer Quality of Life Questionnaire; EQ-5D = EuroQOL 5 dimension; FACT-L = Functional Assessment of Cancer Therapy-Lung; NSCLC = non–small-cell lung cancer; QOL = quality of life; SF-36 = Short Form 36 Health Survey

From: Discussion

Cover of Local Nonsurgical Therapies for Stage I and Symptomatic Obstructive Non–Small-Cell Lung Cancer
Local Nonsurgical Therapies for Stage I and Symptomatic Obstructive Non–Small-Cell Lung Cancer [Internet].
Comparative Effectiveness Reviews, No. 112.
Ratko TA, Vats V, Brock J, et al.

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