Cullinane Carey A, Borneman Tami, Smith David D, Chu David Z J, Ferrell Betty R, Wagman Lawrence D
Department of General Oncologic Surgery, City of Hope National Medical Center, Duarte, California 91010, USA.
Cancer. 2003 Nov 15;98(10):2266-73. doi: 10.1002/cncr.11777.
Costs associated with the provision of medical care continue to escalate. Therefore, providers must evaluate the cost-effectiveness and benefit to individual healthcare practices. The authors evaluated the immediate and short-term resource utilization needs of patients undergoing surgical intervention with curative or palliative intent.
Three hundred two patients undergoing surgery with therapeutic intent were observed from the time of admission for intervention until the time of death or until 6 months from the time of the surgical procedure. Surgeons preoperatively identified each case as either curative or palliative in intent. Demographic information, as well as the nature of all interactions with the cancer center, was recorded.
Surgeons identified 58 (19%) procedures as palliative and 244 (81%) as curative in intent. Demographic characteristics between the two groups were similar, although recurrent or metastatic disease was more often present in palliative rather than curative patients (P = 0.0078) and palliative intent patients were more likely to have received previous therapy. During the 6-month period, 4690 encounters occurred with the cancer center. The mean number of encounters per patient in each group was similar, although curative intent patients were more likely to have visits with therapeutic intent including chemotherapy administration (P = 0.01), radiation (P = 0.003), or repeat surgical procedures (P = 0.006). In contrast, palliative patients were more likely to be admitted for management of symptoms (P = 0.0001) and had fewer hospital-free days than did curative patients (P = 0.0069).
The average number of encounters for patients undergoing treatment of disease was not significantly different, suggesting that patients undergoing surgery with palliative intent do not require a greater amount of resources than curative intent patients. The nature of the interactions, however, was different, suggesting that resource needs are different and may need to be anticipated in the assessment of how better quality outcomes can be achieved in the palliative surgery setting.
提供医疗护理的相关成本持续攀升。因此，医疗服务提供者必须评估个体医疗实践的成本效益和益处。作者评估了接受具有治愈或姑息目的手术干预的患者的即时和短期资源利用需求。
观察了302例接受具有治疗目的手术的患者，从入院接受干预直至死亡或手术操作后6个月。外科医生在术前将每个病例确定为治愈性或姑息性目的。记录了人口统计学信息以及与癌症中心所有互动的性质。
外科医生确定58例（19%）手术为姑息性目的，244例（81%）为治愈性目的。两组之间的人口统计学特征相似，尽管姑息性患者比治愈性患者更常出现复发或转移性疾病（P = 0.0078），且姑息性目的患者更有可能接受过先前的治疗。在6个月期间，与癌症中心发生了4690次接触。每组中每位患者的平均接触次数相似，尽管治愈性目的患者更有可能进行具有治疗目的的就诊，包括化疗给药（P = 0.01）、放疗（P = 0.003）或重复手术（P = 0.006）。相比之下，姑息性患者更有可能因症状管理而入院（P = 0.0001），且无住院天数比治愈性患者少（P = 0.0069）。
接受疾病治疗的患者的平均接触次数没有显著差异，这表明接受姑息性手术的患者与接受治愈性手术的患者相比，并不需要更多的资源。然而，互动的性质不同，这表明资源需求不同，在评估如何在姑息性手术环境中实现更好的质量结果时可能需要对此加以预期。
