End-of-Life Care in Patients with Metastatic Lung Cancer Harboring Epidermal Growth Factor Receptor Mutations
End-of-Life Care in Patients with Metastatic Lung Cancer Harboring Epidermal Growth Factor Receptor Mutations
复制标题
DOI：
10.1089/jpm.2016.0180
复制
发表时间：
2016-12-01
影响因子：
2.8
通讯作者：
Temel, Jennifer S.
中科院分区：
文献类型：
--
作者：
Bauman, Jessica R.;Piotrowska, Zofia;Temel, Jennifer S.
背景/目的：携带表皮生长因子受体（EGFR）突变的转移性非小细胞肺癌（NSCLC）患者可通过EGFR导向治疗改善生存率和生活质量。我们试图探索癌症护理的这些改善是否影响了该人群的临终（EOL）护理。设计图：我们回顾性审查了在我们机构接受治疗的诊断为转移性EGFR突变型NSCLC的患者的病历，这些患者于2015年1月死亡。结果：纳入61例患者。大多数患者为女性（68%）、白色或亚洲人（97%）以及从不吸烟或少量吸烟者（76%）。58例患者中有42例（72%）在死亡后30天内接受了化疗。61例患者中有41例（67%）在死亡后30天内住院。已知53例患者的EOL结局。其中，34例（64%）患者入组临终关怀。临终关怀的中位住院时间为6天（范围0-206）。33例（62%）患者在家中接受临终关怀服务或在住院临终关怀机构死亡。18例患者（34%）在医院死亡。结论：携带EGFR突变的转移性NSCLC患者在生命的最后一个月内化疗使用率和住院率较高，许多人在医院死亡。接近终末期的住院和临终关怀的短期住院是终末期护理质量差的指标，可能是该人群长期化疗的结果。因此，目前的医疗保健提供模式可能不足以为EGFR突变患者提供全面的EOL护理。
Background/Objective: Patients with metastatic nonsmall cell lung cancer (NSCLC) harboring epidermal growth factor receptor (EGFR) mutations benefit from improved survival and quality of life with EGFR-directed therapy. We sought to explore if these improvements in cancer care impacted the delivery of end-of-life (EOL) care in this population. Design: We retrospectively reviewed medical records of patients cared for at our institution with the diagnosis of metastatic EGFR-mutant NSCLC who died by January 2015. Results: Sixty-one patients were included. The majority of patients were female (68%), white or Asian (97%), and never or minimal smokers (76%). Forty-two out of fifty-eight patients (72%) received chemotherapy within 30 days of death. Forty-one out of sixty-one patients (67%) had a hospital admission within 30 days of death. EOL outcomes were known for 53 patients. Of these, 34 (64%) patients enrolled on hospice. The median length of stay on hospice was 6 days (range 0-206). Thirty-three (62%) patients died at home with hospice services or at an inpatient hospice facility. Eighteen patients (34%) died in the hospital. Conclusion: Patients with metastatic NSCLC harboring EGFR mutations had high rates of chemotherapy use and hospital admissions in the last month of life, and many died in the hospital. Hospital admissions near the EOL and short admissions to hospice are indicators of poor quality EOL care and are likely a result of prolonged chemotherapy administration in this population. Thus, current healthcare delivery models may be insufficient to provide comprehensive EOL care for patients with EGFR mutations.