Burt Jenni, Raine Rosalind
Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK.
Age Ageing. 2006 Sep;35(5):469-76. doi: 10.1093/ageing/afl001. Epub 2006 Jun 3.
To investigate variations in the use of specialist palliative care (SPC) services for adult cancer patients, in relation to age.
Systematic review of studies examining use of or referral to SPC services in adult cancer patients.
Six electronic databases (Medline, Embase, Web of Science, HMIC, SIGLE and AgeInfo) were searched for studies published between 1966 and March 2005, and references in the articles identified were also examined. Inclusion criteria were all studies which provided data on age in relation to use of or referral to SPC. Two reviewers independently selected studies, extracted data and assessed methodological quality according to defined criteria.
Use of or referral to SPC services, determined from all sources of report (patient, informal carer, health care professional, health care records).
14 Studies were identified. All reported a statistically significant lower use of SPC among older cancer patients (65 and above or older) at a univariate level [crude odds ratios ranged from 0.33 (0.15-0.72) to 0.82 (0.80-0.82)]. However, there were important methodological weaknesses in all of the studies identified; most crucially, studies failed to consider variations in use in relation to need for SPC.
There is some evidence that older people are less likely to be referred to, or to use, SPC. These findings require confirmation in studies using prospectively collected data which control for patient's need for SPC.
调查成年癌症患者专科姑息治疗（SPC）服务的使用情况与年龄的关系。
对研究成年癌症患者SPC服务使用或转诊情况的研究进行系统综述。
检索了六个电子数据库（Medline、Embase、Web of Science、HMIC、SIGLE和AgeInfo），查找1966年至2005年3月期间发表的研究，并检查所识别文章中的参考文献。纳入标准为所有提供与SPC使用或转诊相关年龄数据的研究。两名评审员根据既定标准独立选择研究、提取数据并评估方法学质量。
从所有报告来源（患者、非正式照料者、医护专业人员、医疗记录）确定SPC服务的使用或转诊情况。
共识别出14项研究。所有研究均报告，在单变量水平上，老年癌症患者（65岁及以上或更高年龄）使用SPC的情况在统计学上显著较低[粗比值比范围从0.33（0.15 - 0.72）至0.82（0.80 - 0.82）]。然而，所识别的所有研究在方法学上均存在重要缺陷；最关键的是，研究未考虑与SPC需求相关的使用差异。
有证据表明老年人被转诊至或使用SPC的可能性较小。这些发现需要在前瞻性收集数据且控制患者SPC需求的研究中得到证实。
