Barbera Lisa, Paszat Lawrence, Qiu Feng
Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada.
J Pain Symptom Manage. 2008 Mar;35(3):267-74. doi: 10.1016/j.jpainsymman.2007.04.019. Epub 2008 Jan 14.
The purpose of this study was to describe (1) the aggressiveness of care in a population of patients who die of lung cancer and (2) differences in care between a sample of lung cancer patients who died in an acute care hospital (DH) and a sample of lung cancer patients who were admitted to hospital during the last six months of life but were discharged and died elsewhere (DO). All lung cancer deaths in 2002 were identified in the provincial registry. Cases were linked to administrative sources of health care data to describe the population as a whole and the aggressiveness of the care that they received. Primary data were collected from a province-wide sample of patients' hospital charts focusing on reasons for admission, care in hospital, advanced planning, pain, and disposition. In total, 5,855 patients who died of lung cancer in 2002 were eligible for inclusion in the cohort. Rates of in-hospital death, emergency room visits, intensive care unit admissions, and chemotherapy use near the end of life were 59.5%, 32.2%, 5.5%, and 4.6%, respectively. The records of 491 patients were abstracted for this study. The DH and DO groups were similar with respect to age, gender, neighborhood income level, and extent of metastatic disease. The most common chief complaints were shortness of breath, pain, inability to cope at home, and altered level of consciousness. Compared to patients in the DO group, those in the DH group presented with pain more often (19% vs. 10%, P<0.005) and were more likely to be admitted with progressive chest malignancy (30% vs. 21%, P<0.05). Regardless of reason for admission, pain was commonly documented as a problem during admission: 73.5% in the DH group and 62.4% in the DO group (P<0.05). Lung cancer patients are heavy users of acute care beds and the emergency room at the end of life. Those who do or do not die in hospital are similar in many respects but our results suggest those dying in hospital have more problems with pain and burden from local chest malignancy.
（1）死于肺癌患者群体中的积极治疗情况；（2）在急症医院（DH）死亡的肺癌患者样本与在生命最后六个月入院但出院后在其他地方死亡的肺癌患者样本（DO）之间的治疗差异。2002年所有肺癌死亡病例均在省级登记处被识别。病例与医疗保健数据的行政来源相联系，以描述整个群体及其接受的治疗的积极程度。从全省范围内的患者医院病历样本中收集原始数据，重点关注入院原因、住院治疗、提前规划、疼痛和处置情况。2002年共有5855名死于肺癌的患者符合纳入该队列的条件。临终时的住院死亡率、急诊就诊率、重症监护病房入住率和化疗使用率分别为59.5%、32.2%、5.5%和4.6%。本研究提取了491名患者的记录。DH组和DO组在年龄、性别、邻里收入水平和转移疾病程度方面相似。最常见的主要症状是呼吸急促、疼痛、在家中无法自理和意识水平改变。与DO组患者相比，DH组患者更常出现疼痛（19%对10%，P<0.005），且因进行性胸部恶性肿瘤入院的可能性更高（30%对21%，P<0.05）。无论入院原因如何，疼痛在入院期间通常被记录为一个问题：DH组为73.5%，DO组为62.4%（P<0.05）。肺癌患者在生命末期大量使用急症病床和急诊室。在医院死亡和未在医院死亡的患者在许多方面相似，但我们的结果表明，在医院死亡的患者在疼痛和局部胸部恶性肿瘤负担方面存在更多问题。
