Is there any association between where patients spend the end of life and survival after anticancer treatment for gynecologic malignancy?
Is there any association between where patients spend the end of life and survival after anticancer treatment for gynecologic malignancy?
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妇科恶性肿瘤患者的临终时间与接受抗癌治疗后的生存率之间是否存在关联？
DOI：
10.1089/jpm.2013.0366
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发表时间：
2014
期刊：
影响因子：
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通讯作者：
Kikkawa F.
中科院分区：
文献类型：
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作者：
Kajiyama H;Utsumi F;Higashi M;Sakata J;Sekiya R;Mizuno M;Umezu T, Suzuki S;Yamamoto E;Mitsui H;Niimi K;Shibata K;Kikkawa F.
背景：目前尚不清楚临终 (EOL) 环境是否影响抗癌治疗后的生存，特别是妇科恶性肿瘤。目的：本研究的目的是阐明生存时间是否因患者度过 EOL 的地点而异。方法：这项回顾性研究包括接受初始肿瘤治疗但因癌症复发和/或进展而死亡的患者。研究对象是 2002 年至 2008 年同一机构的 181 例妇科恶性肿瘤病例。测量的是癌症治疗后生存期 (PCS)，定义为复发/进展后最后一次抗癌治疗日期与疾病死亡之间的时间间隔，按支持治疗类型或患者度过 EOL 的地点进行分层分析。结果：中位生存时间为 26.1 (1.0-306.4) 个月。癌类型分布如下：宫颈癌（N=52）占28.7%，子宫内膜癌（N=50）占27.6%，卵巢癌（N=79）占43.1%。中位 PCS 为 13.3 周。临终关怀/家庭护理组患者的 PCS 明显优于医院组患者（对数等级：P=0.029）。在多变量分析中，年龄（<60岁与≥60岁）和支持治疗地点（医院与临终关怀/家庭护理）作为PCS不良的独立预后因素保留了其重要性（年龄：HR=0.679，95% CI，0.496-0.928，P=0.0151；支持治疗地点：HR=0.704，95% CI， 0.511–0.970,P=0.0319）。结论：我们当前的数据可以生成假设； EOL 环境可能是抗癌治疗后生存的关键预后因素。
Background:It remains unknown whether the end-of-life (EOL) environment influences survival after anticancer treatment, particularly for gynecologic malignancy.Objective:The study's objective was to clarify whether the survival time varied depending on where patients spend the EOL.Methods:This retrospective study included patients who received initial oncologic treatment but died due to cancer recurrence and/or progression. The subjects were a cohort of 181 gynecologic malignant tumor cases in a single institution from 2002 to 2008. Measurement was of postcancer treatment survival (PCS), defined as the time interval between the last date of anticancer treatment after recurrence/progression and death from the disease, analyzed on stratification by type of supportive care or where patients spent the EOL.Results:The median survival time was 26.1 (1.0–306.4) months. The distribution of the carcinoma type was as follows: 28.7% of patients with cervical (N=52), 27.6% with endometrial (N=50), and 43.1% with ovarian (N=79) cancer. The median PCS was 13.3 weeks. Patients in the hospice/home care group showed a significantly more favorable PCS than those in the hospital group (log rank:P=0.029). On multivariate analysis, the age (<60 versus ≥60) and site of supportive care (hospital versus hospice/home care) retained their significance as independent prognostic factors of poor PCS (age: HR=0.679, 95% CI, 0.496–0.928,P=0.0151; site of supportive care: HR=0.704, 95% CI, 0.511–0.970,P=0.0319).Conclusions:Our current data could be hypothesis generating; it is possible that the EOL environment is a crucial prognostic factor for survival after anticancer treatment.