Dying with cancer, living well with advanced cancer
Dying with cancer, living well with advanced cancer
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DOI：
10.1016/j.ejca.2008.02.024
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发表时间：
2008-07-01
影响因子：
8.4
通讯作者：
Costantini, Massimo
中科院分区：
文献类型：
--
作者：
Higginson, Irene J.;Costantini, Massimo
导言。欧洲每年有170万人死于癌症，世界卫生组织(WHO)估计，到2020年，全球将有超过1500万人经历癌症，每年将有1000万人死于癌症。此外，随着新疗法的开发，人们患癌症的寿命比过去更长，癌症患者将变得更加老龄化。我们使用基于流行病学的需求评估方法来估计欧洲出现症状和问题的人数，公布的数据和综述来评估治疗选择、沟通问题、家庭护理、丧亲和影响护理的社会人口因素，并使用欧洲的一项调查来考虑服务的类型。此外，我们使用系统的文献回顾数据来评价服务的有效性和影响死亡地点的因素。几乎所有晚期癌症患者的生活质量都会受到一种或多种症状的影响，包括情感、社交、精神和沟通方面的担忧。患者平均有11种症状。在欧洲，每年有多达160万名疼痛患者，其中约三分之一的患者病情严重，需要复杂的治疗。几乎同样数量的人受到疲劳的影响，超过1/2的人受到焦虑和/或抑郁、呼吸困难、失眠、恶心、便秘和/或厌食症的影响。影响死亡地点的因素有一个复杂的相互作用--与疾病、个人和环境有关--尽管大多数人希望死在家里，但在大多数国家，大多数癌症患者死于医院。针对病人和家属的需求，系统回顾显示了姑息关怀服务的有效性。然而，整个欧洲的服务分配是不平等的。姑息治疗越来越被认为是癌症治疗的重要组成部分，但需要在研究、教育和服务方面进行投资，纳入适当的需求评估和结果衡量。(C)2008爱思唯尔有限公司。保留所有权利。
Introduction. There are 1.7 million deaths from cancer in Europe each year and by 2020 the World Health Organisation (WHO) estimates that, globally, more than 15 million people will experience cancer and 10 million will die from it each year. Furthermore, as new therapies are developed, people are living longer with cancer than in the past, and the population with cancer will be older.Materials and methods. We used epidemiologically based needs assessment approaches to estimate the number of people in Europe with symptoms and problems, published data and reviews to appraise treatment options, issues of communication, family care, bereavement and socio-demographic factors affecting care, and a European survey to consider the types of services. in addition, we used systematic literature review data to appraise the effectiveness of services and factors affecting place of death.Results. The quality of life of virtually all cancer patients with advanced disease is impaired by one or more symptoms, emotional, social, spiritual and communication concerns. Patients have a median of 11 symptoms. In Europe there are up to 1.6 million patients with pain each year, and in around one third of these it will be severe, requiring complex treatment. Almost an equal number are affected by fatigue, and more than 1 in 2 are affected by anxiety and/or depression, breathlessness, insomnia, nausea, constipation and/or anorexia. There is a complex interaction of factors affecting place of death - related to illness, the individual and environment - and although most people want to die at home, in most countries the majority of cancer patients die in hospital. In response to patient and family needs, systematic review shows the effectiveness of palliative care services. However, the distribution of services across Europe is inequitable.Conclusion. Palliative care is becoming increasingly recognised as a vital component of cancer care, but requires investment in research, education and services, incorporating appropriate needs assessment and outcome measurements. (C) 2008 Elsevier Ltd. All rights reserved.