End-of-life care for cancer patients in Japanese acute care hospitals: A nationwide retrospective administrative database survey
End-of-life care for cancer patients in Japanese acute care hospitals: A nationwide retrospective administrative database survey
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DOI：
10.1093/jjco/hyy117
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发表时间：
2018-10-01
影响因子：
2.4
通讯作者：
Ishioka, Chikashi
中科院分区：
文献类型：
--
作者：
Sato, Yuko;Miyashita, Mitsunori;Ishioka, Chikashi
背景：日本急症护理医院的临终 (EOL) 癌症护理尚未得到很好的描述。方法：我们旨在评估 EOL 护理的积极性，并使用健康管理数据库检查癌症患者的常见治疗方法。受试者是 2011 年 4 月至 2014 年 3 月期间在急症护理医院死亡的成年癌症患者。分析了日本诊断程序组合数据库的数据，以衡量护理的积极性（化疗、重症监护病房 [ICU] 入住和心肺复苏 [CPR]），并描述生命最后 14 和 30 天内实施的程序和处方，按医院病例量分类：高、中和低量。结果： 248,978 名癌症死者中，170,024 人死于高容量医院，70,231 人死于中容量医院，8,723 人死于低容量医院。生命最后 14 天的积极治疗包括化疗（分别为 9.4%、7.3% 和 5.4%）、入住 ICU（3.0%、2.0% 和 2.4%）和心肺复苏（5.8%、6.4% 和 8.3%）。在过去 30 天内，分别有 66.0%、59.0% 和 49.4% 的患者使用了阿片类药物，而姑息治疗团队干预分别为 8.5%、2.2% 和 2.0% 的患者进行。在流量大的医院，放疗和经认证的门诊化疗费用更加频繁。儿茶酚胺和高营养在低容量医院中的使用频率更高。结论：这是第一项评估日本急症护理医院的 EOL 护理的研究。在大容量医院更频繁地使用化疗可能反映了完善的癌症治疗系统。低容量医院的方法可能会改善日本所有癌症患者的临终护理。
Background: End-of-life (EOL) cancer care in Japanese acute care hospitals has not been well described.Methods: We aimed to assess the aggressiveness of EOL care and examine common treatments administered to cancer patients using a health administrative database. Subjects are adult cancer patients who died at acute care hospitals between April 2011 and March 2014. Data from the Japanese Diagnosis Procedure Combination database were analysed to measure the aggressiveness of care (chemotherapy, intensive care unit [ICU] admission and cardiopulmonary resuscitation [CPR]) and describe procedures and prescriptions administered in the last 14 and 30 days of life, disaggregated by hospital case volume: high, intermediate and low volumes.Results: Of 248,978 cancer decedents, 170,024 died in high-, 70,231 in intermediate- and 8,723 in low-volume hospitals. Aggressive treatment in the last 14 days of life included chemotherapy (9.4%, 7.3%, and 5.4%, respectively), ICU admission (3.0%, 2.0%, and 2.4%) and CPR (5.8%, 6.4%, and 8.3%). Opioids were administered to 66.0%, 59.0% and 49.4% patients, while Palliative Care Team intervention was performed for 8.5%, 2.2% and 2.0% of patients, respectively in the last 30 days. In high- volume hospitals, radiotherapy and certified outpatient chemotherapy fees were more frequent. Catecholamines and hyperalimentation were more frequently administered in low-volume hospitals.Conclusion: This is the first study to assess EOL care among Japanese acute care hospitals. More frequent use of chemotherapy at high- volume hospitals may reflect a well-established cancer treatment system. The approach for low-volume hospitals might improve the EOL care for all cancer patients in Japan.