Multicenter cohort study on the survival time of cancer patients dying at home or in a hospital: Does place matter?
Multicenter cohort study on the survival time of cancer patients dying at home or in a hospital: Does place matter?
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DOI：
10.1002/cncr.29844
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发表时间：
2016-05-01
期刊：
影响因子：
6.2
通讯作者：
Morita, Tatsuya
中科院分区：
文献类型：
--
作者：
Hamano, Jun;Yamaguchi, Takashi;Morita, Tatsuya
研究背景虽然死亡地点对癌症患者的死亡和死亡质量有很大影响，但生存时间是否因死亡地点而异尚不清楚。本研究的主要目的是探讨在家中或在hospital. METHODS死亡的癌症患者的生存时间的潜在差异，这项多中心，前瞻性队列研究是从2012年9月至2014年4月在日本进行的，涉及58个专科姑息治疗服务。1582人接受医院姑息治疗，487人接受家庭姑息治疗。共有1607名患者实际在医院死亡，462名患者在家中死亡。在天数预后组中，在家中死亡的患者的生存时间明显长于在医院死亡的患者（估计中位生存时间，13天[95%置信区间（CI），10.3-15.7天] vs 9天[95% CI，8.0-10.0天]; P= 0.006）和周预后组（36天[95% CI，29.9-42.1天] vs 29天[95% CI，26.5-31.5天]; P= 0.007），根据姑息治疗研究预测模型A中的预后定义。在月预后组中没有发现显著差异。考克斯比例风险分析显示，死亡地点对未校正的两组患者的生存时间有显著影响（风险比[HR]，0.86; 95%CI，0.78-0.96; P
BACKGROUNDAlthough the place of death has a great influence on the quality of death and dying for cancer patients, whether the survival time differs according to the place of death is unclear. The primary aim of this study was to explore potential differences in the survival time of cancer patients dying at home or in a hospital.METHODSThis multicenter, prospective cohort study was conducted in Japan from September 2012 through April 2014 and involved 58 specialist palliative care services.RESULTSAmong the 2426 patients recruited, 2069 patients were analyzed for this study: 1582 receiving hospital-based palliative care and 487 receiving home-based palliative care. A total of 1607 patients actually died in a hospital, and 462 patients died at home. The survival of patients who died at home was significantly longer than the survival of patients who died in a hospital in the days' prognosis group (estimated median survival time, 13 days [95% confidence interval (CI), 10.3-15.7 days] vs 9 days [95% CI, 8.0-10.0 days]; P=.006) and in the weeks' prognosis group (36 days [95% CI, 29.9-42.1 days] vs 29 days [95% CI, 26.5-31.5 days]; P=.007) as defined by Prognosis in Palliative Care Study predictor model A. No significant difference was identified in the months' prognosis group. Cox proportional hazards analysis revealed that the place of death had a significant influence on the survival time in both unadjusted (hazard ratio [HR], 0.86; 95% CI, 0.78-0.96; P