Patterns and predictors of end-of-life care in older patients with pancreatic cancer.
Patterns and predictors of end-of-life care in older patients with pancreatic cancer.
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老年胰腺癌患者临终关怀的模式和预测因素。
DOI：
10.1002/cam4.1861
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发表时间：
2018-12
期刊：
影响因子：
4
通讯作者：
Hur C
中科院分区：
文献类型：
--
作者：
Nipp RD;Tramontano AC;Kong CY;Hur C
关于胰腺癌（PDAC）患者的临终关怀知之甚少。我们使用了监测、流行病学和最终结果-医疗保险链接数据库来分析PDAC患者的临终关怀使用和临终治疗模式。我们纳入了2000 - 2011年间诊断为PDAC且在2012年12月31日前死亡的患者。我们评估了临终关怀的使用模式，化疗的接受和重症监护室（ICU）的入院。我们使用多变量logistic回归来研究临终关怀的预测因素。在我们的16309例患者队列中，70.5%的患者参加了临终关怀，其中29.1%在生命的最后7天参加。临终关怀的使用随着时间的推移而增加，从2000年的61.6%增加到2012年的77.5%（趋势P值<0.0001）。在整个队列中，6.4%在生命的最后14天内接受化疗，13.1%在生命的最后30天内入住ICU。随着时间的推移，晚期ICU入院人数增加，而临终时接受化疗的人数减少。年龄较大、女性、社会经济地位较高、或来自南部或中西部的患者更有可能参加临终关怀。那些年轻或男性更有可能接受化疗或在生命结束时入住ICU。虽然临终关怀的招募与PDAC患者中增加，后期招募仍然发生在相当大比例的患者。虽然临终时的化疗略有减少，但临终时的ICU入院人数继续增加。需要进一步的研究来确定加强PDAC患者临终关怀的有效方法。
Little is known about end‐of‐life care among patients with pancreatic adenocarcinoma (PDAC). We used the Surveillance, Epidemiology, and End Results‐Medicare linked database to analyze patterns of hospice use and end‐of‐life treatment in patients with PDAC. We included patients diagnosed with PDAC between 2000‐2011 and who had died by December 31, 2012. We assessed patterns of hospice use, chemotherapy receipt, and intensive care unit (ICU) admissions at end‐of‐life. We used multivariable logistic regression to investigate predictors of end‐of‐life care. In our cohort of 16 309 patients, 70.5% enrolled in hospice, of which 29.1% enrolled in the last 7 days of life. Use of hospice increased over time, from 61.6% in 2000 to 77.5% in 2012 (P‐value for trend <0.0001). Among the entire cohort, 6.4% received chemotherapy within the last 14 days of life and 13.1% were admitted to the ICU within the last 30 days of life. Late ICU admissions increased over time, while chemotherapy receipt at the end‐of‐life decreased. Patients who were older, female, with higher SES, or from the South or Midwest were more likely to enroll in hospice. Those who were younger or male were more likely to receive chemotherapy or have an ICU admission at the end‐of‐life. Although hospice enrollment has increased among patients with PDAC, late enrollment still occurs in a substantial proportion of patients. While chemotherapy at the end‐of‐life has decreased slightly, ICU admissions at the end‐of‐life have continued to increase. Further research is needed to determine effective ways of enhancing end‐of‐life care for patients with PDAC.
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