Best supportive care in lung cancer trials is inadequately described: a systematic review

The objective of the paper was to identify and discuss clinical terms associated with the availability and delivery of best supportive care for patients with lung cancer in randomised controlled clinical trials. Systematic review was carried out of relevant studies without language restrictions identified through Medline, EMBASE, Science Citation Index (Web of Science and ISI Proceedings) and Cochrane Library. Reference lists of retrieved articles were also searched to identify further studies. Articles describing randomised controlled trials or systematic reviews with a comparator arm of best supportive care for patients with lung cancer were studied. Definitions of best supportive care and elements of best supportive care were reported. Included clinical studies (n = 40) did not adequately describe or outline either the components or the delivery of best supportive care for patients in lung cancer trials. None of the identified studies provided a clear definition of a patient pathway in relation to best supportive care, or a clear list of components. Clinical studies are being conducted without a clear definition of the best supportive care provided in the comparator arms of trials. Inadequate definitions mean that all direct and indirect comparisons in trials comparing active treatments with best supportive care must be interpreted with caution.