Association of Palliative Care Consultation With Reducing Inpatient Chemotherapy Use in Elderly Patients With Cancer in Japan: Analysis Using a Nationwide Administrative Database
Association of Palliative Care Consultation With Reducing Inpatient Chemotherapy Use in Elderly Patients With Cancer in Japan: Analysis Using a Nationwide Administrative Database
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DOI：
10.1177/1049909116650238
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发表时间：
2017-08-01
影响因子：
1.9
通讯作者：
Fushimi, Kiyohide
中科院分区：
文献类型：
--
作者：
Sano, Motoko;Fushimi, Kiyohide
背景：在生命结束时进行化疗被认为是一种积极的延长生命的治疗方法。老年患者在生命末期使用不必要的积极治疗是一个重要的卫生保健问题。目的：通过分析国家数据库的数据，探讨姑息治疗咨询（PCC）对日本老年肿瘤住院患者化疗使用的影响。方法：我们对年龄65岁的患者进行了一项多中心队列研究，这些患者在日本国家行政保健数据库中登记，在2010年4月至2013年3月住院期间死于晚期（3期）肺癌、胃癌、结直肠癌、肝癌或乳腺癌。PCC与生命最后2周内化疗的关系采用（2）和Logistic回归分析。结果：我们纳入了26012例患者。平均年龄为75.74 ± 6.40岁，68.1%为男性，81.8%有复发癌，29.5%有肺癌，29.5%有胃癌。其中，3134人（12%）接受了PCC。在接受PCC的患者中，46例患者（1.5%）接受了化疗，3088例患者（98.5%）未接受化疗。在未接受PCC的患者中，909例患者（4%）接受了化疗，其余21978例患者未接受化疗（96%;比值比[OR]，0.35; 95%置信区间，0.26-0.48）。化疗使用的OR是较高的男性，老年人，和原发性cancer.Conclusion患者：姑息治疗咨询与化疗使用较少的老年日本癌症患者谁死在医院设置。
Background: The administration of chemotherapy at the end of life is considered an aggressive life-prolonging treatment. The use of unnecessarily aggressive therapy in elderly patients at the end of life is an important health-care concern.Objective: To explore the impact of palliative care consultation (PCC) on chemotherapy use in geriatric oncology inpatients in Japan by analyzing data from a national database.Methods: We conducted a multicenter cohort study of patients aged 65 years, registered in the Japan National Administrative Healthcare Database, who died with advanced (stage 3) lung, stomach, colorectal, liver, or breast cancer while hospitalized between April 2010 and March 2013. The relationship between PCC and chemotherapy use in the last 2 weeks of life was analyzed using (2) and logistic regression analyses.Results: We included 26 012 patients in this analysis. The mean age was 75.74 6.40 years, 68.1% were men, 81.8% had recurrent cancer, 29.5% had lung cancer, and 29.5% had stomach cancer. Of these, 3134 (12%) received PCC. Among individuals who received PCC, chemotherapy was administered to 46 patients (1.5%) and was not administered to 3088 patients (98.5%). Among those not receiving PCC, chemotherapy was administered to 909 patients (4%) and was not administered to the remaining 21 978 patients (96%; odds ratio [OR], 0.35; 95% confidence interval, 0.26-0.48). The OR of chemotherapy use was higher in men, young-old, and patients with primary cancer.Conclusion: Palliative care consultation was associated with less chemotherapy use in elderly Japanese patients with cancer who died in the hospital setting.