Analysis Of Survival And Prognostic Factors Of Small Cell Lung Cancer Based On The Internet + TCM Chronic Disease Management Model

BACKGROUND:Small cell lung cancer(SCLC)is characterized by high degree of malignancy,rapid progression,and easy recurrence and metastasis.Although the role of modern medicine in tumor reduction remains unchallenged,Traditional Chinese Medicine(TCM)scholars have also explored the treatment of SCLC.Based on some clinical observations,the comprehensive combination of TCM and modern medical treatment can alleviate the adverse reactions caused by surgery,radiotherapy,chemotherapy,targeted or immunotherapy,improve symptoms,promote the recovery of body function,and improve the quality of life.At present,there are few studies on prolonging OS and PFS,but there are also a few clinical observation studies with small sample size,and the results show that TCM maintenance treatment of SCLC has a certain effect on prolonging OS and PFS.With the development of medical treatment and science technology,the management of chronic diseases is gradually informationized and networked.A number of clinical studies at home and abroad have shown that the Internet plus chronic disease management model is feasible and effective,which is worth using and promoting in clinical practice.With the development of new drugs and the updating of treatment methods,SCLC will gradually develop from a rapidly progressing malignant disease to a preventable,controllable and treatable chronic disease in the future.Therefore,the management of chronic diseases in SCLC patients should also be improved.To analyze the previous research on the prevention and treatment of lung cancer by traditional TCM and the application research of mobile medical APP or interactive platform derived from Internet plus in other diseases,it is concluded that the promotion and application of TCM guidelines for lung cancer has produced good social and economic benefits,which provides a strong theoretical and practical support for the establishment of Internet plus SCLC TCM chronic disease management system.OBJECTIVE:To explore and establish the Internet plus SCLC TCM chronic disease management platform with TCM comprehensive intervention measures as the core,and objectively evaluate the impact of TCM chronic disease management on OS,PFS and TCM clinical symptoms in the treatment of SCLC,laying a foundation for further platform construction and application and information collection and mining of big data research.METHODS:To establish a management system of Internet plus SCLC TCM chronic disease management system based on comprehensive intervention measures of traditional Chinese medicine.A patient-terminal information collection and detection system(patient-terminal APP)and a collaborative diagnosis,treatment and data research management system(doctor-terminal APP,platform page)were established and put into use.Chronic disease management was used as an exposure factor in a prospective cohort study,which was divided into Internet plus group and control group according to whether the exposure factor was accepted or not.The control group was treated according to the principles of the 2017 edition of NCCN guidelines for clinical practice of SCLC combined with comprehensive treatment of TCM.On the basis of the treatment in the control group,the Internet plus group performed chronic disease management through the Internet plus platform.Two cohorts were followed after 4 treatment cycles.Efficacy indicators were OS,PFS,and clinical symptoms of TCM.Epidata3.1 database was used for data entry and SPSS20.0 software was used for statistical analysis.RESULTS:From November 2017 to April 2019,a total of 55 SCLC patients who met the admission criteria were included in Guanganmen Hospital of the Chinese Academy of Chinese Medical Sciences,27 in the Internet plus group and 28 in the control group.Baseline situation:there was no statistical difference between the two groups at baseline level(P>0.05)in gender,age,smoking history,family tumor history,stage status,primary lesion site,metastatic site,KPS score,TCM symptom score,chest radiotherapy implementation,PCI implementation and targeted or immunotherapy.Main results:MST in the Internet plus group and the control group was 20.97 months and 18.03 months,P=0.700.In ES-SCLC,MST in the Internet plus group was not reached,and MST in the control group was 16.47 months,P=0.169.MPFS in the Internet plus group and the control group were 10.17 months and 7.90 months,P=0.408.In LS-SCLC,mPFS in the Internet plus group and the control group was 14.70 months and 7.52 months,P=0.368.In ES-SCLC,mPFS in the Internet plus group and the control group was 9.10 months and 7.90 months,P=0.837.Single factor impact OS analysis showed that MST of patients without pleural effusion was extended by 9.4 months compared with patients with pleural effusion,P=0.003.MST of patients without pleural metastasis was extended by 11.24 months conpared with patients with pleural metastasis,P=0.000.The difference was statistically significant.Multivariate analysis showed that the prognostic factor affecting OS in SCLC patients was pleural metastasis(P=0.020),and the regression coefficient was 1.356>0,indicating that pleural metastasis was an adverse prognostic factor and the relative risk was 3.880.Secondary results:There was no statistically significant difference in the mean value of KPS and changes compared to baseline between the two cohorts,P>0.05.In this study,the total scores of NCI adverse reactions in the blood,digestive and urinary systems of the two groups were observed.The mean comparison of the total scores of NCI adverse reactions between the two groups has no statistically significant difference,P>0.05.The TCM symptom scores of the two groups decreased significantly,with no statistically significant difference,but the effective rate of the Internet plus group was greater than the control group,which was more obvious at the first,second and third follow-up.Investigation on the usage of Internet plus chronic disease management platform:In the Internet plus group,the compliance of the re-examination prescription and on-time review rate are higher,and it takes shorter time to see a doctor,the acquisition degree of inspection data and the acquisition degree of tongue coating photos were more timely and complete than those in the control group.Comparison P between the two groups was less than 0.05,and the difference was statistically significant.The feasibility of using patient-side APP in the test group was investigated,14 patients(51.9%)were satisfied,10(37.0%)feel generally and 3(11.1%)feel poor.7 people(25.9%)were satisfied with the use of patient-side APP,16(59.3%)feel generally and 4(14.8%)feel poor.CONCLUSIONS:1 The Internet plus TCM chronic disease management platform for SCLC can collect patient information and data more conveniently,reduce consumables,better follow-up and management of patients.Patients can save time,reduce negative emotions and improve the quality of life.2 TCM comprehensive treatment can alleviate the clinical symptoms of SCLC patients,reduce adverse reactions,improve the prognosis of SCLC patients,and has certain advantages in the prevention and treatment of recurrence and metastasis of SCLC patients,which is more reflected in ES-SCLC patients.Internet plus analyzed data can more objectively reflect some current status of SCLC.