ESTIMATE OF SURVIVAL OF PATIENTS ADMITTED TO A PALLIATIVE CARE UNIT - A PROSPECTIVE-STUDY
ESTIMATE OF SURVIVAL OF PATIENTS ADMITTED TO A PALLIATIVE CARE UNIT - A PROSPECTIVE-STUDY
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DOI：
10.1016/0885-3924(92)90118-2
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发表时间：
1992-02-01
影响因子：
4.7
通讯作者：
HANSON, J
中科院分区：
文献类型：
--
作者：
BRUERA, E;MILLER, MJ;HANSON, J
在一项前瞻性的开放研究中，61名连续入院的晚期癌症患者在入院第一天进行了全面的体检后，由两名独立医生进行了生存评估。一名独立的研究护士也在入院的第一天对每个患者进行了评估。评估包括活动、疼痛、恶心、抑郁、焦虑、厌食、口干、呼吸困难、吞咽困难、体重减轻和认知状态。评估完成后，对患者进行跟踪，直到出院或死亡。在47名可评估的患者中，Logistic回归分析显示，患者的存活率与吞咽困难、认知障碍和体重减轻显著相关。因此，任何体重减轻10公斤或以上并伴有认知障碍(简易精神状态问卷24)并伴有吞咽困难的患者被认为是预后不良的指标。与医生1号和医生2号的评估相比，这一指标具有类似的敏感性、特异性和总体准确性，并具有更高的显著性水平。我们的数据表明，三个简单的决定，可以由护士执行，可以预测生存期或多或少4周，以及两个熟练的医生的评估。这些结果需要在其他有大量患者的试验中得到证实。也许这些结果的确认和其他预后因素的确定将导致晚期癌症患者生存评估的分期系统的建立。
In a prospective open study, 61 consecutive patients with advanced cancer admitted to a Palliative Care Unit underwent survival estimation by two independent physicians after a complete medical exam performed during the first day of admission. An independent research nurse also assessed each patient during the first day of admission. The assessment included activity, pain, nausea, depression, anxiety, anorexia, dry mouth, dyspnea, dysphagia, weight loss, and cognitive status. After the assessment was completed, patients were followed until discharge or death. In 47 evaluable patients, logistic regression showed a significant correlation between survival and dysphagia, cognitive failure, and weight loss. Accordingly, an "indicator of poor prognosis" was considered to exist in any patient who demonstrated weight loss of 10 kg or more plus cognitive failure (Mini-Mental State Questionnaire < 24) plus dysphagia to solids or liquids. This indicator had a similar level of sensitivity, specificity, and overall accuracy, and a higher level of significance as compared with the assessment by physician #1 and physician #2, respectively. Our data suggest that three simple determinations, which may be performed by a nurse, can predict survival more or less than 4 wk as well as the assessments of two skilled physicians. These results need to be confirmed in other trials with large numbers of patients. Perhaps confirmation of these results and identification of other prognostic factors will result in staging systems for survival estimation of terminally ill cancer patients.