Comparing Three Life-Limiting Diseases: Does Diagnosis Matter or Is Sick, Sick?
Comparing Three Life-Limiting Diseases: Does Diagnosis Matter or Is Sick, Sick?
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DOI：
10.1016/j.jpainsymman.2010.11.006
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发表时间：
2011-09-01
影响因子：
4.7
通讯作者：
Tulsky, James A.
中科院分区：
文献类型：
--
作者：
Steinhauser, Karen E.;Arnold, Robert M.;Tulsky, James A.
上下文在晚期阶段，癌症、充血性心力衰竭（CHF）和慢性阻塞性肺病（COPD）产生高的住院率、残疾率和年死亡率。尽管有类似的疾病，但癌症患者的治疗往往与其他疾病患者不同，前者被视为晚期与慢性。本研究的目的是比较三个疾病组患者的功能能力、情绪健康和生活质量，以评估诊断是否区分患者经历的差异，并比较癌症和非癌症诊断的患者。分析了一项队列研究的基线数据，该研究包括210例两年死亡率估计为50%的患者。患者患有IV期乳腺癌、前列腺癌或结肠癌; IIIb或IV期肺癌;纽约心脏协会III或IV期CHF，左心室射血分数为46），并且在过去一年中至少有一次住院或急诊就诊。测量包括Rosow-Breslau日常生活活动/日常生活工具活动，情绪状态焦虑子量表，流行病学研究中心抑郁量表和癌症治疗功能评估-一般生活质量工具。分析方法包括描述性统计、方差分析和校正线性回归模型。大多数疾病的结果没有不同的诊断类别。功能状态与诊断相关，CHF和COPD患者的情况比癌症患者更糟。总体而言，疾病经历与疾病严重程度、人口统计学特征、情感和社会幸福感最显著相关。晚期癌症、慢性心力衰竭和慢性阻塞性肺病患者的疾病经历相似性大于差异性。患有癌症以外的其他限制生命的疾病的患者可能会受益于通常扩展到癌症患者的全人服务。J Pain Symptom Manage 2011;42：331-341. (C)2011年美国癌症疼痛缓解委员会。爱思唯尔公司出版All rights reserved.
Context. At advanced stages, cancer, congestive heart failure (CHF), and chronic obstructive pulmonary disease (COPD) produce high rates of hospitalization, disability, and annual mortality. Despite similar prognoses, patients with cancer often are treated differently than those with other illnesses, the former being seen as terminal vs. chronic.Objectives. The purpose of this study was to compare the functional capacity, emotional well-being, and quality of life of patients in three disease groups to assess whether diagnosis distinguishes differences in patient experience, and compare patients with cancer and noncancer diagnoses.Methods. Baseline data from a cohort study of 210 patients who had an estimated 50% two-year mortality were analyzed. The patients had Stage IV breast, prostate, or colon cancer; Stage IIIb or IV lung cancer; New York Heart Association Stage III or IV CHF with a left ventricular ejection fraction of 46) and at least one hospitalization or Emergency Department visit during the past year. Measures included the Rosow-Breslau Activities of Daily Living/Instrumental Activities of Daily Living tool, Profile of Mood States anxiety subscale, brief Centers for Epidemiologic Studies Depression Scale, and the Functional Assessment of Cancer Therapy-General quality-of-life instrument. Analyses included descriptive statistics, analysis of variance, and adjusted linear regression models.Results. A majority of illness outcomes did not differ by diagnostic category. Functional status was associated with diagnosis, with CHF and COPD patients faring worse than those with cancer. Overall, illness experience was most significantly related to disease severity, demographics, and emotional and social well-being.Conclusion. Comparing patients with advanced cancer, CHF, and COPD, illness experience was more similar than different. Patients living with life-limiting illnesses other than cancer may benefit from whole-person services often extended to cancer patients. J Pain Symptom Manage 2011;42:331-341. (C) 2011 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.