Symptom Expression in the Last Seven Days of Life Among Cancer Patients Admitted to Acute Palliative Care Units
Symptom Expression in the Last Seven Days of Life Among Cancer Patients Admitted to Acute Palliative Care Units
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DOI：
10.1016/j.jpainsymman.2014.09.003
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发表时间：
2015-10-01
影响因子：
4.7
通讯作者：
Bruera, Eduardo
中科院分区：
文献类型：
--
作者：
Hui, David;dos Santos, Renata;Bruera, Eduardo
上下文晚期癌症患者生命最后一周的症状负担尚未得到很好的表征。研究在急性姑息治疗病房（APCU）中能够交流并死亡的患者在生命的最后7天内症状的频率、强度和预测因素。我们系统地记录了埃德蒙顿症状评估系统（ESAS）每天和15个症状每天两次连续晚期癌症患者在MD安德森癌症中心（美国）的APCU。2010/2011年，巴西Barretos癌症医院从入院到死亡或出院的时间。我们检查了死亡后症状的频率和强度。357名患者中共有203人死亡。在生命的最后七天，能够交流的患者比例从80%下降到39%。ESAS厌食症（纵向分析P = 0.001）、嗜睡（P < 0.0001）、疲劳（P < 0.0001）、健康状况差（P = 0.01）和呼吸困难（P < 0.0001）的强度在接近死亡时增加。相反，ESAS抑郁（P = 0.008）随着时间的推移而减少。在生命的最后几天，固体（P = 0.01）和液体（P = 0.005）吞咽困难以及尿失禁（P = 0.0002）也出现在越来越多的患者中。多变量分析显示，女性、非西班牙裔和肺癌与ESAS症状表达显著相关（优势比> 1）。尽管在APCU中进行了强化管理，但一些癌症患者在接近死亡时仍会经历高症状负担。(C)2015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. The symptom burden in the last week of life of patients with advanced cancer has not been well characterized.Objectives. To examine the frequency, intensity, and predictors for symptoms in the last seven days of life among patients who were able to communicate and died in an acute palliative care unit (APCU).Methods. We systematically documented the Edmonton Symptom Assessment System (ESAS) daily and 15 symptoms twice daily on consecutive advanced cancer patients admitted to APCUs at MD Anderson Cancer Center (U.S.) and Barretos Cancer Hospital (Brazil) from admission to death or discharge in 2010/2011. We examined the frequency and intensity of the symptoms from death backward.Results. A total of 203 of 357 patients died. The proportion of patients able to communicate decreased from 80% to 39% over the last seven days of life. ESAS anorexia (P = 0.001 in longitudinal analyses), drowsiness (P < 0.0001), fatigue (P < 0.0001), poor well-being (P = 0.01), and dyspnea (P < 0.0001) increased in intensity closer to death. In contrast, ESAS depression (P = 0.008) decreased over time. Dysphagia to solids (P = 0.01) and liquids (P = 0.005) as well as urinary incontinence (P = 0.0002) also were present in an increasing proportion of patients in the last few days of life. In multivariate analyses, female sex, non-Hispanic race, and lung cancer were significantly associated with higher ESAS symptom expression (odds ratio > 1).Conclusion. Despite intensive management in APCUs, some cancer patients continue to experience high symptom burden as they approached death. (C) 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.