Cheng Wen-Wu, Willey Jie, Palmer J Lynn, Zhang Tao, Bruera Eduardo
Shanghai Cancer Hospital, Fudan University, China.
J Palliat Med. 2005 Oct;8(5):1025-32. doi: 10.1089/jpm.2005.8.1025.
In recent years, patients with advanced cancer are referred more frequently to palliative care programs. However, the referrals usually occur relatively late for the management of severe physical and psychological distress. The purpose of this retrospective study was to investigate the interval between palliative care referral and death in patients with advanced cancer. We reviewed charts of 240 consecutive patients with advanced cancer referred to the palliative care program at M.D. Anderson Cancer Center between September and December 2003. Demographics, as well as dates of cancer diagnosis, advanced disease diagnosis, palliative care referral, and death were determined. The median age was 61 years old, 173 were male, 304 patients had solid tumors, and 26 had hematologic malignancies. The median time intervals between the diagnosis of the primary cancer and death, diagnosis of advanced disease and death, advanced disease and palliative care referral, and palliative care referral and death were 33.0 months (95% confidence interval [CI]: 25.8-41.9), 9.4 months (95% CI: 7.9-11.1), 5.6 months (95% CI: 4.3-7.7), and 1.9 months (95% CI: 1.6-2.2), respectively. The patients' median time interval from advanced cancer diagnosis to death and from palliative care referral to death was shorter in patients with hematologic malignancies than in those with sold tumors (p = 0.018 and p < 0.001, respectively). Median time interval between palliative care referral and death was longer for patients less than 65 year old than those 65 years old or more (p = 0.03). Our results should help palliative care and oncology programs at comprehensive cancer centers plan how to develop joint programs for patient care.
近年来，晚期癌症患者被更频繁地转介至姑息治疗项目。然而，这些转介通常在处理严重的身体和心理痛苦方面相对较晚。这项回顾性研究的目的是调查晚期癌症患者从转介至姑息治疗到死亡的时间间隔。我们回顾了2003年9月至12月期间连续转诊至MD安德森癌症中心姑息治疗项目的240例晚期癌症患者的病历。确定了人口统计学信息以及癌症诊断日期、晚期疾病诊断日期、姑息治疗转介日期和死亡日期。中位年龄为61岁，173例为男性，304例患者患有实体瘤，26例患有血液系统恶性肿瘤。原发性癌症诊断与死亡之间、晚期疾病诊断与死亡之间、晚期疾病与姑息治疗转介之间以及姑息治疗转介与死亡之间的中位时间间隔分别为33.0个月（95%置信区间[CI]：25.8 - 41.9）、9.4个月（95%CI：7.9 - 11.1）、5.6个月（95%CI：4.3 - 7.7）和1.9个月（95%CI：1.6 - 2.2）。血液系统恶性肿瘤患者从晚期癌症诊断到死亡以及从姑息治疗转介到死亡的中位时间间隔比实体瘤患者短（分别为p = 0.018和p < 0.001）。年龄小于65岁的患者从姑息治疗转介到死亡的中位时间间隔比65岁及以上的患者长（p = 0.03）。我们的结果应有助于综合癌症中心的姑息治疗和肿瘤项目规划如何制定联合患者护理项目。
