Changes in medication profile among patients with advanced cancer admitted to an acute palliative care unit.
Changes in medication profile among patients with advanced cancer admitted to an acute palliative care unit.
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入住急性姑息治疗病房的晚期癌症患者的药物情况变化。
DOI：
10.1007/s00520-014-2390-1
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发表时间：
2015
期刊：
影响因子：
--
通讯作者：
Bruera,Eduardo
中科院分区：
文献类型：
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作者：
Hui,David;Li,Zhijun;Chisholm,GaryB;Didwaniya,Neha;Bruera,Eduardo
目的由于患者虚弱和预后不良，生命最后几周的药物使用决策过程很复杂。关于姑息治疗环境中药物使用的文献有限，特别是在急性姑息治疗病房（APCU）中。我们检查了住院晚期癌症患者在姑息治疗住院咨询团队转诊前、姑息治疗咨询后、APCU 入院时以及 APCU 出院或死亡时的用药情况变化。方法我们纳入了连续的晚期癌症患者，他们首先由我们的住院姑息治疗咨询团队接诊，随后入住 APCU。我们在预先指定的时间点检索了所有预定药物的数据。结果在 100 名患者中，住院时间中位数为 10.5 天（四分位数范围为 8-15 天），APCU 住院时间中位数为 5 天（四分位数范围为 3-7 天）。姑息治疗住院咨询团队转诊前、姑息治疗咨询后、APCU 入院时和 APCU 出院/死亡时的平均药物数量分别为 9.2（标准差 [SD] 4.5）、9.9（SD 4.2）、10.3（SD 3.8）和 10.1（SD 3.8）（P= 0.03）。越来越多的患者在住院期间接受用于控制症状的药物治疗，包括全身性皮质类固醇、泻药、精神安定药和抗溃疡药（P< 0.05）。相比之下，抗高血压药、抗血脂药和抗惊厥药等几类药物的使用频率随着时间的推移而下降（P<0.05）。结论随着时间的推移，姑息治疗的参与与症状控制药物的增加和共病药物的减少相关。
PurposeThe decision-making process for medication use in the last weeks of life is complex because of patient frailty and poor prognosis. Limited literature is available on medication use in the palliative care setting, particularly in acute palliative care units (APCUs). We examined the changes in medication profile among hospitalized patients with advanced cancer before their palliative care inpatient consultation team referral, after palliative care consultation, at the time of APCU admission, and at APCU discharge or death.MethodsWe included consecutive patients with advanced cancer who were first seen by our inpatient palliative care consultation team and subsequently admitted to the APCU. We retrieved data on all scheduled medications at the prespecified time points.ResultsAmong the 100 patients, the median duration of hospitalization was 10.5 days (interquartile range 8–15 days), and the median APCU stay was 5 days (interquartile range 3–7 days). The average number of medications before palliative care inpatient consultation team referral, after palliative care consultation, at APCU admission and at APCU discharge/death was 9.2 (standard deviation [SD] 4.5), 9.9 (SD 4.2), 10.3 (SD 3.8), and 10.1 (SD 3.8), respectively (P= 0.03). An increasing proportion of patients received medications for symptom control over their course of hospitalization, including systemic corticosteroids, laxatives, neuroleptics, and antiulcer agents (P< 0.05). In contrast, the frequency of several classes of medications such as antihypertensives, antilipemics, and anticonvulsants decreased over time (P< 0.05).ConclusionsPalliative care involvement was associated with an increase in symptom control medications and decrease in medications for comorbid conditions over time.