Interval between first palliative care consult and death in patients diagnosed with advanced cancer at a comprehensive cancer center
Interval between first palliative care consult and death in patients diagnosed with advanced cancer at a comprehensive cancer center
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DOI：
10.1089/jpm.2007.0103
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发表时间：
2008-01-01
影响因子：
2.8
通讯作者：
Bruera, Eduardo
中科院分区：
文献类型：
--
作者：
El Osta, Badi;Palmer, J. Lynn;Bruera, Eduardo
目的：大多数转诊至姑息治疗和临终关怀的患者发生在疾病发展轨迹的晚期，尽管早期干预可以减轻患者的症状苦恼。这项研究的目的是确定在我们综合癌症中心确诊的晚期癌症(ACA)患者第一次姑息治疗会诊(PC1)到死亡(D)的间隔时间，以及这个间隔是否随着时间的推移而增加。方法：研究组连续2868名患者在30个月期间进行了PC1治疗。结果：女性患者1,404例(49%)，65岁以下患者1791例(62%)，实体瘤2563例(89%)，白人患者2004年例(70%)。PC1-D、ACA-PC1、ACA-D和CA-D间期的中位数分别为42、147、250和570天。实体瘤患者(p<；0.0001)、65岁以下患者(p=0.002)和女性患者(p=0.004)的PC1D间期中位数较长。PC1-D不受种族影响(p=0.42)。连续5个半年的PC1-D间期中位数分别为46、56、42、41和34天(p=0.02)。在此期间，PC1的数量从544个增加到654个(20%)。PC在ACA-D期间的受累比率(PC1-D/ACA-D)在5个半年期间从0.3降至0.26(p=0.0004)。结论：本中心首次姑息治疗会诊至死亡的时间间隔随着时间的推移而减少。我们的转诊医生需要进行教育，以便更早地获得姑息治疗。需要进行前瞻性研究，以确定首次姑息治疗咨询的适当时间。
Purpose: Most referrals to palliative care and hospice occur late in the trajectory of the disease although an earlier intervention could decrease patients' symptom distress. The purpose of this study was to determine the interval between first palliative care consult (PC1) and death ( D) in patients diagnosed with advanced cancer (aCA) at our comprehensive cancer center and if such interval has increased over time.Methods: The study group was 2868 consecutive patients who had their PC1 during a 30-month period. We reviewed the charts for information about demographics, cancer type, date of cancer ( CA) diagnosis, aCA diagnosis, PC1, and D. aCA was defined as locally recurrent or metastatic.Results: One thousand four hundred four patients (49%) were female, 1791 (62%) were less than 65 years old, 2563 (89%) had solid tumors, and 2004 (70%) were white. The median PC1-D, aCA-PC1, aCA-D, and CA-D intervals were 42, 147, 250, and 570 days, respectively. The median PC1D interval was longer in patients with solid tumors ( p < 0.0001), less than 65 years old ( p = 0.002), and females ( p = 0.004). PC1-D was not affected by ethnicity ( p = 0.42). The median PC1-D interval in 5 consecutive half-years was 46, 56, 42, 41, and 34 days, respectively ( p = 0.02). The number of PC1 in this period increased from 544 to 654 (20%). The ratio of PC involvement in the aCA-D period (PC1-D/aCA-D) decreased from 0.30 to 0.26 over the 5 half-year periods ( p = 0.0004).Conclusions: The first palliative care consultation to death interval has decreased over time at our center. Education is needed among our referring physicians for earlier access to palliative care. Prospective studies are needed to establish the appropriate timing of the first palliative care consultation.