老年晚期非小细胞肺癌姑息治疗获益研究进展
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摘要
在中国,肺癌的发病率和病死率均居恶性肿瘤的第一位。有近一半的肺癌发生在年龄大于70岁的老年患者。肺癌中约85%是非小细胞肺癌(non-small cell lung cancer,NSCLC),且大多数肺癌患者发现时已属中晚期。老年晚期NSCLC患者具有伴随疾病多、器官功能衰退等特点。制定恰当的治疗策略是我们面临的挑战。姑息治疗作为特殊的医疗关怀,是老年晚期NSCLC的重要治疗方式之一。低剂量局部姑息放疗可以有效改善老年NSCLC患者的呼吸道症状,且副作用可以耐受;对于表皮生长因子受体(epidermal growth factor receptor,EGFR)突变的老年晚期NSCLC,吉非替尼在疾病控制率、症状缓解等方面均可使老年患者从治疗中获益。同时,老年晚期NSCLC患者对厄洛替尼也显示出良好的耐受性;氩氦刀在治疗老年NSCLC患者的应用有增加趋势且患者对氩氦刀技术的耐受性和反应性都较好。中医药在改善临床症状、减少放化疗的毒副作用和提高生活质量方面有较好的疗效;社会心理支持疗法在一定程度上可缓解NSCLC患者的困扰,但其系统性有待完善。姑息治疗的评估和介入时机,是患者能否从中获益的重要因素。文章介绍了老年NSCLC姑息治疗获益研究的进展,为老年NSCLC的姑息治疗提供依据。
Lung cancer is the leading cause of death among all cancers in China. It also has the highest incidence when compared to other cancers. Almost half of all lung cancers occur over 70-year-old. Approximately 85% of all lung cancers are non-small cell lung cancer(NSCLC). The majority of patients are advanced lung cancer. Due to the unique alterations in physiology, elderly patients are at a greater risk of toxicity from chemotherapy. Palliative care as a special medical care is an important treatment for elderly patients with advanced NSCLC. Low-dose palliative radiotherapy can improve respiratory symptoms in elderly patients with NSCLC, with the tolerated side effects. Elderly patients with epidermal growth factor receptor(EGFR) mutation can benefit from gefitinib and have a good tolerate of erlotiib. Cryocare Surgical System has an increasing trend of application in the treatment of elderly patients with NSCLC. Chinese medicine has effects in improving clinical symptoms and reducing side effects of chemotherapy, it can also improve the quality of life in these patients. Psychosocial support therapy can alleviate the burden of patients with NSCLC to some extent, but needs to improve its systematicness. Assessment and the time of palliative care are two important factors which determine the outcome of patients. We introduce the progress in palliative care benefit of elderly NSCLC, in order to provide the basis for palliative care of elderly NSCLC.
Lung cancer is the leading cause of death among all cancers in China. It also has the highest incidence when compared to other cancers. Almost half of all lung cancers occur over 70-year-old. Approximately 85% of all lung cancers are non-small cell lung cancer(NSCLC). The majority of patients are advanced lung cancer. Due to the unique alterations in physiology, elderly patients are at a greater risk of toxicity from chemotherapy. Palliative care as a special medical care is an important treatment for elderly patients with advanced NSCLC. Low-dose palliative radiotherapy can improve respiratory symptoms in elderly patients with NSCLC, with the tolerated side effects. Elderly patients with epidermal growth factor receptor(EGFR) mutation can benefit from gefitinib and have a good tolerate of erlotiib. Cryocare Surgical System has an increasing trend of application in the treatment of elderly patients with NSCLC. Chinese medicine has effects in improving clinical symptoms and reducing side effects of chemotherapy, it can also improve the quality of life in these patients. Psychosocial support therapy can alleviate the burden of patients with NSCLC to some extent, but needs to improve its systematicness. Assessment and the time of palliative care are two important factors which determine the outcome of patients. We introduce the progress in palliative care benefit of elderly NSCLC, in order to provide the basis for palliative care of elderly NSCLC.
引文
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2 Chen W,Zheng R,Zhang S,et at.Annual report on status of cancer in China,2010.Chin J Cancer Res,2014,26(l):48-58.
3 Senior adult oncology guideline.Version 2.2 2012.National Comprehensive Cancer Network.
4 Wang H,Qiao YL.Epidemiology,etilogy and prevention of elderly cancer.Zhonghua Lao Nian Duo Qi Guan Ji Bing Za Zhi,2005,4(3):170-172.[王鹤,乔友林.老年恶性肿瘤流行病学、病因及预防.中华老年多器官疾病杂志,2005,4(3):170-172.]
5 Yancik R.Epidemiology of cancer in the elderly:current status and projections for the future.Rays,1997,22(l Suppl):3-9.
6 Lang K,MarciniakMD,Faries D,et al.Trends and predictors of first-line chemotherapy use among elderly patients with advanced non-small-cell lung cancer in the United States.Lung Cancer,2009,63(2):264-270.
7 Coate LE,Massey C,Hope A,et al.Treatment of the elderly when cure is the goal:the influence of age on treatment selection and efficacy for stageⅢnon-small cell lung cancer.J Thorac Oncol,2011,6(3):537-544.
8 Jacob S,Hovey E,Ng W,et al.Estimation of an optimal chemotherapy utilisation rate for lung cancer:an evidence-based benchmark for cancer care.Lung Cancer,2010,69(3):307-314.
9 Davidoff AJ,Tang M,Seal B,et al.Chemotherapy and survival benefit in elderly patients with advanced non-small-cell lung cancer.J Clin Oncol,2010,28(13):2191-2197.
10 Clinical Practice Guidelines in Oncology Palliative Care Version1.2014.National Comprehensive Cancer Network.
11 1994-2015 China Academic Journal Electronic Publishing House.Available at http://www.cnki.net/.
12 TemelJS,Greer JA,Muzikansky A,et al.Early palliative care for patients with metastatic non-small-cell lung cancer.N Engl J Med,2010,363(8):733-742.
13 Langendijk JA,Ten VGP,Aaronson NK,et al.Quality of life after palliative radiotherapy in non-small cell lung cancer:a prospective study.Int J Radiat Oncol Biol Phys,2000,47(1):149-155.
14 Lonardi F,Coeli M,Pavanato G,et al.Radiotherapy for non-small cell lung cancer in patients aged 75 and over:safety,effectiveness and possible impact on survival.Lung Cancer,2000,28(1):43-50.
15 Cross CK,Berman S,Buswell L,et al.Prospective study of palliative hypofractionated radiotherapy(8.5 Gy x 2)for patients with symptomatic non-small-cell lung cancer.Int J Radiat Oncol Biol Phys,2004,58(4):1098-1105.
16 Takahashi K,Saito H,Hasegawa Y,et al.First-line gefitinib therapy for elderly patients with non-small cell lung cancer harboring EGFR mutation:Central Japan Lung Study Group 0901.Cancer Chemother Pharmacol,2014,74(4):721-727.
17 Morikawa N,Minegishi Y,Inoue A,et al.First-line gefitinib for elderly patients with advanced NSCLC harboring EGFR mutations.A combined analysis of North-East Japan Study Group studies.Expert Opin Pharmacother,2015,16(4):465-472.
18 Jackman DM,Yeap BY,Lindeman NI,et al.Phase II clinical trial of chemotherapy-naive patients>=70 years of age treated with erlotinib for advanced non-small-cell lung cancer.J Clin Oncol,2007,25(7):760-766.
19 Yoshioka H,Komuta K,Imamura F,et al.Efficacy and safety of erlotinib in elderly patients in the phase IVPOLARSTAR surveillance study of Japanese patients with non-small-cell lung cancer.Lung Cancer,2014,86(2):201-206.
20 Chen SH,Ma TJ,Cui W,et al.Clinical application of erlotinib in elderly patients with non-small cell lung cancer with brain metastasis.Zhongguo Shi YongYi Yao,2005,10(2):132-133.[陈素华,马天江,崔巍,等.厄洛替尼在老年非小细胞肺癌脑转移治疗中的临床应用中国实用医药,2005,10(2):132-133.]
21 Leighl NB,Zatloukal P,Mezger J,et al.Efficacy and safety of bevacizumab-based therapy in elderly patients with advanced or recurrent non-squamous non-small cell lung cancer in the phaseⅢBO17704 study(AVAIL).J Thorac Oncol,2010,5(12):1970-1976.
22 Ramalingam SS,Dahlberg SE,Langer CJ,et al.Outcomes for elderly,advanced-stage non small-cell lung cancer patients treated with bevacizumab in combination with carboplatin and paclitaxel:analysis of Eastern Cooperative Oncology Group Trial 4599.J Clin Oncol,2008,26(1):60-65.
23 Zhou YF,Lin CL.Clinical observation of argon-helium minimally invasive targeted ablation of lung cancer in elderly.HeilongjiangYi Yao,2007,20(6):646-647.[周玉芳,林彩莲.微创氩氦靶向消融治疗老年肺癌的临床观察.黑龙江医药,2007,20(6):646-647.]
24 Hu KW,Li QW,Zuo MH,et al.Clinical observation on the combined treatment of 57 cases of non-small cell lung cancer using argon-helium cryosurgery and Chinese herbal medicine.Chin J Integr Med,2007,13(3):224-227.
25 Song Q,Zhan Y,Li LJ.Clinical observation of CT-guided percutaneous cryoablation treatment of elderly patients with lung cancer 60 cases.Zhongguo Lao Nian Xue Za Zhi,2010,30(7):1002-1003.[宋谦,詹瑛,李露嘉.CT引导经皮氩氦刀靶向治疗老年人肺癌60例临床观察.中国老年学杂志,2010,30(7):1002-1003.]
26 Fu CH,Cao Y.Safety analysis and influence observation of argon helium cryoablation in the treatment of senile non-small cell lung cancer.Zhongguo Xian Dai Yi Yao Ying Yong,2014,8(23):13-14.[付朝红,曹旸.氩氦刀冷冻消融治疗老年非小细胞肺癌的安全性分析及对肺功能影响的观察.中国现代药物应用,2014,8(23):13-14.]
27 Jiang M.Clinical observation of endocare targeted cryoablation therapy plus taxol and cisplatin regimen in elderly non-small cell lung cancer.Zhongguo Lao Nian Xue Za Zhi,2011,31(23):4557-4559.[蒋明.氩氦刀联合TP方案治疗老年非小细胞肺癌的临床观察.中国老年学杂志,2011,31(23):4557-4559.]
28 Zhang CX,Cui HX,Wang C.Clinical observation of endocare targeted cryoablation therapy plus chemotherapy in advanced stage elderly nonsmall cell lung cancer.Zhongguo Yi Yao Zhi Nan,2011,9(20):208-209.[张彩霞,崔洪霞,王成.氩氦刀联合化疗治疗中晚期老年非小细胞肺癌临床观察.中国医药指南,2011,9(20):208-209.]
29 Zuo HM,Li QW,Hu KW.Five flavors ling gan jiang xin decoction treatment of cough induced by endocare targeted cryoablation therapy in elderly non-small cell lung cancer.Beijing Zhong Yi Yao Da Xue Xue Bao(Zhong Yi Lin Chuang Ban),2009,16(6):19.[左明焕,李泉旺,胡凯文.苓甘五味姜辛汤加味治疗老年非小细胞肺癌氩氦刀冷冻术后咳嗽的临床观察.北京中医药大学学报(中医临床版),2009,16(6):19.]
30 You J,Shan MJ,Zhao H.Clinical study integrative treatment for ninety-one elderly patients with advanced non-small cell lung cancer.Zhongguo Zhong Xi Yi Jie He Za Zhi,2012,32(6):774-778.[游捷,单孟俊,赵慧,等.中西医结合治疗91例老年晚期非小细胞肺癌疗效观察.中国中西医结合杂志,2012,32(6):774-778.]
31 Sun SK,Guo HY,Cong LX,et al.Jiawei shen qi decoction improvement in elderly lung cancer patients with comlications.Zhongguo Lao Nian Xue Za Zhi,2014,34(24):6901-6903.[孙守坤,郭环宇,丛立新,等.加味参芪汤对老年肺癌患者并发症的改善作用.中国老年学杂志,2014,34(24):6901-6903.]
32 Liu W,Jiang YL,Cao PH,et al.Clinical observation of lung-boosting and toxin-vanquishing decoction for maintenance treatment of advanced non-small cell lung cancer.Liaoning Zhong Yi Za Zhi,2014,41(11):2389-2391.[刘伟,蒋益兰,曾普华,等.益肺败毒方维持治疗晚期非小细胞肺癌临床观察.辽宁中医杂志,2014,41(11):2389-2391.]
33 Yang ZY,Hu CG.Efficacy of xiao-ai-ping injection treatment of elderly patients with advanced non-small cell lung cancer 121 cases.Anllui Yi Yao,2010,14(12):1470-1471.[杨宗艳,胡传国.消癌平注射液治疗老年晚期非小细胞肺癌121例疗效观察.安徽医药,2010,14(12):1470-1471.]
34 Uitterhoeve RJ,Vernooy M,Litjens M,et al.Psychosocial interventions for patients with advanced cancer-a systematic review of the literature.Br J Cancer,2004,91(6):1050-1062.
35 Kuchler TH,Henne-Bruns D,Rappat S,et al.Impact of psychotherapeutic support on gastrointestinal cancer patients undergoing surgery:survival results of a trial.Hepatogastroenterology,1999,46(25):322-335.
36 McCorkle R,Strumpf NE,Nuamah IF,et al.A specialized home care intervention improves survival among older post-surgical cancer patients.J Am Geriatr Soc,2000,48(12):1707-1713.
37 Andersen BL,Yang HC,Farrar WB,et al.Psychologic intervention improves survival for breast cancer patients:a randomized clinical trial.Cancer,2008,113(12):3450-3458.
38 Gellert GA,Maxwell RM,Siegel BS.Survival of breast cancer patients receiving adjunctive psychosocial support therapy:a 10-year follow-up study.J Clin Oncol,1993,11(1):66-69.
39 Goodwin PA,Leszcz M,Ennis M.The effect of group psychosocial support on survival in metastatic breast cancer.N Engl J Med,2001,345(24):1719-1726.
40 Spiegel D,Butler LD,Giese-Davis J,et al.Effects of supportiveexpressive group therapy on survival of patients with metastatic breast cancer:a randomized prospective trial.Cancer,2007,110(5):1130-1138.
41 Movsas B,Moughan J,Sarna L,et al.Quality of life supersedes the classic prognosticators for long-term survival in locally advanced nonsmall-cell lung cancer:an analysis of RTOG 9801.J Clin Oncol,2009,27(34):5816-5822.
42 Gustafson DH,DuBenske LL,Namkoong K,et at.An eHealth system supporting palliative care for patients with non-small cell lung cancer:a randomized trial.Cancer,2013,119(9):1744-1751.
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50 Vergnenegre A,Hominal S,Tchalla AE,et al.Assessment of palliative care for advanced non-small-cell lung cancer in France:a prospective observational multicenter study(GFPC 0804 study).Lung Cancer,2013,82(2):353-357.
51 Reville B,Miller MN,Toner RW,et al.End-of-life care for hospitalized patients with lung cancer:utilization of a palliative care service.J Palliat Med,2010,13(10):1261-1266.
2 Chen W,Zheng R,Zhang S,et at.Annual report on status of cancer in China,2010.Chin J Cancer Res,2014,26(l):48-58.
3 Senior adult oncology guideline.Version 2.2 2012.National Comprehensive Cancer Network.
4 Wang H,Qiao YL.Epidemiology,etilogy and prevention of elderly cancer.Zhonghua Lao Nian Duo Qi Guan Ji Bing Za Zhi,2005,4(3):170-172.[王鹤,乔友林.老年恶性肿瘤流行病学、病因及预防.中华老年多器官疾病杂志,2005,4(3):170-172.]
5 Yancik R.Epidemiology of cancer in the elderly:current status and projections for the future.Rays,1997,22(l Suppl):3-9.
6 Lang K,MarciniakMD,Faries D,et al.Trends and predictors of first-line chemotherapy use among elderly patients with advanced non-small-cell lung cancer in the United States.Lung Cancer,2009,63(2):264-270.
7 Coate LE,Massey C,Hope A,et al.Treatment of the elderly when cure is the goal:the influence of age on treatment selection and efficacy for stageⅢnon-small cell lung cancer.J Thorac Oncol,2011,6(3):537-544.
8 Jacob S,Hovey E,Ng W,et al.Estimation of an optimal chemotherapy utilisation rate for lung cancer:an evidence-based benchmark for cancer care.Lung Cancer,2010,69(3):307-314.
9 Davidoff AJ,Tang M,Seal B,et al.Chemotherapy and survival benefit in elderly patients with advanced non-small-cell lung cancer.J Clin Oncol,2010,28(13):2191-2197.
10 Clinical Practice Guidelines in Oncology Palliative Care Version1.2014.National Comprehensive Cancer Network.
11 1994-2015 China Academic Journal Electronic Publishing House.Available at http://www.cnki.net/.
12 TemelJS,Greer JA,Muzikansky A,et al.Early palliative care for patients with metastatic non-small-cell lung cancer.N Engl J Med,2010,363(8):733-742.
13 Langendijk JA,Ten VGP,Aaronson NK,et al.Quality of life after palliative radiotherapy in non-small cell lung cancer:a prospective study.Int J Radiat Oncol Biol Phys,2000,47(1):149-155.
14 Lonardi F,Coeli M,Pavanato G,et al.Radiotherapy for non-small cell lung cancer in patients aged 75 and over:safety,effectiveness and possible impact on survival.Lung Cancer,2000,28(1):43-50.
15 Cross CK,Berman S,Buswell L,et al.Prospective study of palliative hypofractionated radiotherapy(8.5 Gy x 2)for patients with symptomatic non-small-cell lung cancer.Int J Radiat Oncol Biol Phys,2004,58(4):1098-1105.
16 Takahashi K,Saito H,Hasegawa Y,et al.First-line gefitinib therapy for elderly patients with non-small cell lung cancer harboring EGFR mutation:Central Japan Lung Study Group 0901.Cancer Chemother Pharmacol,2014,74(4):721-727.
17 Morikawa N,Minegishi Y,Inoue A,et al.First-line gefitinib for elderly patients with advanced NSCLC harboring EGFR mutations.A combined analysis of North-East Japan Study Group studies.Expert Opin Pharmacother,2015,16(4):465-472.
18 Jackman DM,Yeap BY,Lindeman NI,et al.Phase II clinical trial of chemotherapy-naive patients>=70 years of age treated with erlotinib for advanced non-small-cell lung cancer.J Clin Oncol,2007,25(7):760-766.
19 Yoshioka H,Komuta K,Imamura F,et al.Efficacy and safety of erlotinib in elderly patients in the phase IVPOLARSTAR surveillance study of Japanese patients with non-small-cell lung cancer.Lung Cancer,2014,86(2):201-206.
20 Chen SH,Ma TJ,Cui W,et al.Clinical application of erlotinib in elderly patients with non-small cell lung cancer with brain metastasis.Zhongguo Shi YongYi Yao,2005,10(2):132-133.[陈素华,马天江,崔巍,等.厄洛替尼在老年非小细胞肺癌脑转移治疗中的临床应用中国实用医药,2005,10(2):132-133.]
21 Leighl NB,Zatloukal P,Mezger J,et al.Efficacy and safety of bevacizumab-based therapy in elderly patients with advanced or recurrent non-squamous non-small cell lung cancer in the phaseⅢBO17704 study(AVAIL).J Thorac Oncol,2010,5(12):1970-1976.
22 Ramalingam SS,Dahlberg SE,Langer CJ,et al.Outcomes for elderly,advanced-stage non small-cell lung cancer patients treated with bevacizumab in combination with carboplatin and paclitaxel:analysis of Eastern Cooperative Oncology Group Trial 4599.J Clin Oncol,2008,26(1):60-65.
23 Zhou YF,Lin CL.Clinical observation of argon-helium minimally invasive targeted ablation of lung cancer in elderly.HeilongjiangYi Yao,2007,20(6):646-647.[周玉芳,林彩莲.微创氩氦靶向消融治疗老年肺癌的临床观察.黑龙江医药,2007,20(6):646-647.]
24 Hu KW,Li QW,Zuo MH,et al.Clinical observation on the combined treatment of 57 cases of non-small cell lung cancer using argon-helium cryosurgery and Chinese herbal medicine.Chin J Integr Med,2007,13(3):224-227.
25 Song Q,Zhan Y,Li LJ.Clinical observation of CT-guided percutaneous cryoablation treatment of elderly patients with lung cancer 60 cases.Zhongguo Lao Nian Xue Za Zhi,2010,30(7):1002-1003.[宋谦,詹瑛,李露嘉.CT引导经皮氩氦刀靶向治疗老年人肺癌60例临床观察.中国老年学杂志,2010,30(7):1002-1003.]
26 Fu CH,Cao Y.Safety analysis and influence observation of argon helium cryoablation in the treatment of senile non-small cell lung cancer.Zhongguo Xian Dai Yi Yao Ying Yong,2014,8(23):13-14.[付朝红,曹旸.氩氦刀冷冻消融治疗老年非小细胞肺癌的安全性分析及对肺功能影响的观察.中国现代药物应用,2014,8(23):13-14.]
27 Jiang M.Clinical observation of endocare targeted cryoablation therapy plus taxol and cisplatin regimen in elderly non-small cell lung cancer.Zhongguo Lao Nian Xue Za Zhi,2011,31(23):4557-4559.[蒋明.氩氦刀联合TP方案治疗老年非小细胞肺癌的临床观察.中国老年学杂志,2011,31(23):4557-4559.]
28 Zhang CX,Cui HX,Wang C.Clinical observation of endocare targeted cryoablation therapy plus chemotherapy in advanced stage elderly nonsmall cell lung cancer.Zhongguo Yi Yao Zhi Nan,2011,9(20):208-209.[张彩霞,崔洪霞,王成.氩氦刀联合化疗治疗中晚期老年非小细胞肺癌临床观察.中国医药指南,2011,9(20):208-209.]
29 Zuo HM,Li QW,Hu KW.Five flavors ling gan jiang xin decoction treatment of cough induced by endocare targeted cryoablation therapy in elderly non-small cell lung cancer.Beijing Zhong Yi Yao Da Xue Xue Bao(Zhong Yi Lin Chuang Ban),2009,16(6):19.[左明焕,李泉旺,胡凯文.苓甘五味姜辛汤加味治疗老年非小细胞肺癌氩氦刀冷冻术后咳嗽的临床观察.北京中医药大学学报(中医临床版),2009,16(6):19.]
30 You J,Shan MJ,Zhao H.Clinical study integrative treatment for ninety-one elderly patients with advanced non-small cell lung cancer.Zhongguo Zhong Xi Yi Jie He Za Zhi,2012,32(6):774-778.[游捷,单孟俊,赵慧,等.中西医结合治疗91例老年晚期非小细胞肺癌疗效观察.中国中西医结合杂志,2012,32(6):774-778.]
31 Sun SK,Guo HY,Cong LX,et al.Jiawei shen qi decoction improvement in elderly lung cancer patients with comlications.Zhongguo Lao Nian Xue Za Zhi,2014,34(24):6901-6903.[孙守坤,郭环宇,丛立新,等.加味参芪汤对老年肺癌患者并发症的改善作用.中国老年学杂志,2014,34(24):6901-6903.]
32 Liu W,Jiang YL,Cao PH,et al.Clinical observation of lung-boosting and toxin-vanquishing decoction for maintenance treatment of advanced non-small cell lung cancer.Liaoning Zhong Yi Za Zhi,2014,41(11):2389-2391.[刘伟,蒋益兰,曾普华,等.益肺败毒方维持治疗晚期非小细胞肺癌临床观察.辽宁中医杂志,2014,41(11):2389-2391.]
33 Yang ZY,Hu CG.Efficacy of xiao-ai-ping injection treatment of elderly patients with advanced non-small cell lung cancer 121 cases.Anllui Yi Yao,2010,14(12):1470-1471.[杨宗艳,胡传国.消癌平注射液治疗老年晚期非小细胞肺癌121例疗效观察.安徽医药,2010,14(12):1470-1471.]
34 Uitterhoeve RJ,Vernooy M,Litjens M,et al.Psychosocial interventions for patients with advanced cancer-a systematic review of the literature.Br J Cancer,2004,91(6):1050-1062.
35 Kuchler TH,Henne-Bruns D,Rappat S,et al.Impact of psychotherapeutic support on gastrointestinal cancer patients undergoing surgery:survival results of a trial.Hepatogastroenterology,1999,46(25):322-335.
36 McCorkle R,Strumpf NE,Nuamah IF,et al.A specialized home care intervention improves survival among older post-surgical cancer patients.J Am Geriatr Soc,2000,48(12):1707-1713.
37 Andersen BL,Yang HC,Farrar WB,et al.Psychologic intervention improves survival for breast cancer patients:a randomized clinical trial.Cancer,2008,113(12):3450-3458.
38 Gellert GA,Maxwell RM,Siegel BS.Survival of breast cancer patients receiving adjunctive psychosocial support therapy:a 10-year follow-up study.J Clin Oncol,1993,11(1):66-69.
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