Earle Craig C, Neville Bridget A, Landrum Mary Beth, Ayanian John Z, Block Susan D, Weeks Jane C
MSc, Center for Outcomes and Policy Research, Dana-Farber Cancer Center, 44 Binney St, 454-STE 21-24, Boston, MA 02115, USA.
J Clin Oncol. 2004 Jan 15;22(2):315-21. doi: 10.1200/JCO.2004.08.136.
To characterize the aggressiveness of end-of-life cancer treatment for older adults on Medicare, and its relationship to the availability of healthcare resources.
We analyzed Medicare claims of 28,777 patients 65 years and older who died within 1 year of a diagnosis of lung, breast, colorectal, or other gastrointestinal cancer between 1993 and 1996 while living in one of 11 US regions monitored by the Surveillance, Epidemiology, and End Results Program.
Rates of treatment with chemotherapy increased from 27.9% in 1993 to 29.5% in 1996 (P =.02). Among those who received chemotherapy, 15.7% were still receiving treatment within 2 weeks of death, increasing from 13.8% in 1993 to 18.5% in 1996 (P <.001). From 1993 to 1996, increasing proportions of patients had more than one emergency department visit (7.2% v 9.2%; P <.001), hospitalization (7.8% v 9.1%; P =.008), or were admitted to an intensive care unit (7.1% v 9.4%; P =.009) in the last month of life. Although fewer patients died in acute-care hospitals (32.9% v 29.5%; P <.001) and more used hospice services (28.3% v 38.8%; P <.001), an increasing proportion of patients who received hospice care initiated this service only within the last 3 days of life (14.3% v 17.0%; P =.004). Black patients were more likely than white patients to experience aggressive intervention in nonteaching hospitals but not in teaching hospitals. Greater local availability of hospices was associated with less aggressive treatment near death on multivariate analysis.
The treatment of cancer patients near death is becoming increasingly aggressive over time.
描述医疗保险覆盖的老年癌症患者临终治疗的激进程度及其与医疗资源可及性的关系。
我们分析了1993年至1996年间居住在美国监测、流行病学和最终结果项目所监测的11个地区之一的28777例65岁及以上患者的医疗保险理赔数据，这些患者在被诊断为肺癌、乳腺癌、结直肠癌或其他胃肠道癌后的1年内死亡。
化疗治疗率从1993年的27.9%升至1996年的29.5%（P = 0.02）。在接受化疗的患者中，15.7%在死亡前2周内仍在接受治疗，从1993年的13.8%增至1996年的18.5%（P < 0.001）。从1993年到1996年，在生命的最后一个月，有超过一次急诊科就诊（7.2%对9.2%；P < 0.001）、住院（7.8%对9.1%；P = 0.008）或入住重症监护病房（7.1%对9.4%；P = 0.009）的患者比例不断增加。尽管在急症医院死亡的患者减少（32.9%对29.5%；P < 0.001），使用临终关怀服务的患者增多（28.3%对38.8%；P < 0.001），但接受临终关怀的患者中，在生命的最后3天内才开始使用该服务的比例在增加（14.3%对17.0%；P = 0.004）。在非教学医院，黑人患者比白人患者更有可能接受激进干预，但在教学医院并非如此。多因素分析显示，当地临终关怀机构的可及性越高，临终时的激进治疗越少。
随着时间的推移，癌症临终患者的治疗越来越激进。
