Breathlessness, Functional Status, Distress, and Palliative Care Needs Over Time in Patients With Advanced Chronic Obstructive Pulmonary Disease or Lung Cancer: A Cohort Study
Breathlessness, Functional Status, Distress, and Palliative Care Needs Over Time in Patients With Advanced Chronic Obstructive Pulmonary Disease or Lung Cancer: A Cohort Study
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DOI：
10.1016/j.jpainsymman.2013.11.011
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发表时间：
2014-10-01
影响因子：
4.7
通讯作者：
Simon, Steffen T.
中科院分区：
文献类型：
--
作者：
Weingaertner, Vera;Scheve, Christine;Simon, Steffen T.
上下文呼吸困难是晚期疾病的一种令人痛苦的症状。随着时间的推移，了解其模式、负担和姑息治疗（PC）需求对改善患者的生活质量非常重要。描述和比较慢性阻塞性肺疾病（COPD）或肺癌（LC）晚期患者随时间推移的难治性呼吸困难、功能状态、痛苦和PC需求的病程。这是一项COPD（III/IV期）或LC患者的队列研究。每月通过多达12次电话访谈对数据进行评估，使用改良的博格量表、Karnofsky行为状态量表、痛苦温度计和姑息治疗结局量表作为结局指标。描述性分析比较了COPD和LC在基线和随时间推移的所有结局（从研究进入开始向前和从死亡开始向后）。共纳入82例患者（50例COPD和32例LC），平均（SD）年龄为67.2（7.8）岁，36%为女性（8例COPD和23例LC死亡）。COPD患者在较低的功能状态下，随着时间的推移，呼吸困难和痛苦水平逐渐升高。LC患者的呼吸困难、痛苦和PC需求增加，而功能状态下降至死亡。疾病组之间的PC需求相似。COPD患者呼吸困难与功能状态呈负相关（COPD =均值r =-0.20，P =0.012; LC =均值r =-0.277，P =0.029），与PC需求呈正相关（均值r = 0.343，P <0.001）。死亡与诊断（LC：危险比= 7.84，P <0.001）和功能状态（下降10%：危险比= 1.52，P = 0.001）有显著相关性。晚期COPD患者的PC需求与LC患者相当，呼吸困难的严重程度和痛苦甚至更高。COPD患者的护理需要进一步改善，以解决症状负担和PC需求。(C)2014年美国临终关怀和姑息医学学会。爱思唯尔公司出版All rights reserved.
Context. Breathlessness is a distressing symptom in advanced disease. Understanding its patterns, burden, and palliative care (PC) needs over time is important to improve patients' quality of life.Objectives. To describe and compare the courses of refractory breathlessness, functional status, distress, and PC needs in patients with advanced chronic obstructive pulmonary disease (COPD) or lung cancer (LC) over time.Methods. This was a cohort study of patients with COPD (Stage III/IV) or LC. Data were assessed monthly with up to 12 telephone interviews, using the modified Borg Scale, Karnofsky Performance Status Scale, Distress Thermometer, and Palliative care Outcome Scale as outcomes measures. Descriptive analysis compared all outcomes between COPD and LC at baseline and over time (forward from study entry and backward from death).Results. A total of 82 patients (50 COPD and 32 LC), mean (SD) age of 67.2 (7.8), and 36% female were included (8 COPD and 23 LC deceased). The patients with COPD perceived higher levels of breathlessness and distress at lower functional status steadily over time. The LC patients' breathlessness, distress, and PC needs increased, whereas functional status decreased toward death. The PC needs were similar between disease groups. Breathlessness was negatively correlated with functional status (COPD = mean r = -0.20, P = 0.012; LC = mean r = -0.277, P = 0.029) and positively correlated with PC needs in COPD patients (mean r = 0.343, P < 0.001). Death was significantly predicted by diagnosis (LC: hazard ratio = 7.84, P < 0.001) and functional status (10% decline: hazard ratio = 1.52, P = 0.001).Conclusion. The PC needs of patients with advanced COPD are comparable with LC patients, and breathlessness severity and distress are even higher. The care for COPD patients requires further improvement to address symptom burden and PC needs. (C) 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.