Osta Badi El, Palmer J Lynn, Paraskevopoulos Timotheos, Pei Be-Lian, Roberts Lynn E, Poulter Valerie A, Chacko Ray, Bruera Eduardo
Department of Palliative Care and Rehabilitation Medicine, The University of Texas-M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
J Palliat Med. 2008 Jan-Feb;11(1):51-7. doi: 10.1089/jpm.2007.0103.
Most referrals to palliative care and hospice occur late in the trajectory of the disease although an earlier intervention could decrease patients' symptom distress. The purpose of this study was to determine the interval between first palliative care consult (PC1) and death (D) in patients diagnosed with advanced cancer (aCA) at our comprehensive cancer center and if such interval has increased over time.
The study group was 2868 consecutive patients who had their PC1 during a 30-month period. We reviewed the charts for information about demographics, cancer type, date of cancer (CA) diagnosis, aCA diagnosis, PC1, and D. aCA was defined as locally recurrent or metastatic.
One thousand four hundred four patients (49%) were female, 1791 (62%) were less than 65 years old, 2563 (89%) had solid tumors, and 2004 (70%) were white. The median PC1-D, aCA-PC1, aCA-D, and CA-D intervals were 42, 147, 250, and 570 days, respectively. The median PC1-D interval was longer in patients with solid tumors (p < 0.0001), less than 65 years old (p = 0.002), and females (p = 0.004). PC1-D was not affected by ethnicity (p = 0.42). The median PC1-D interval in 5 consecutive half-years was 46, 56, 42, 41, and 34 days, respectively (p = 0.02). The number of PC1 in this period increased from 544 to 654 (20%). The ratio of PC involvement in the aCA-D period (PC1-D/aCA-D) decreased from 0.30 to 0.26 over the 5 half-year periods (p = 0.0004).
The first palliative care consultation to death interval has decreased over time at our center. Education is needed among our referring physicians for earlier access to palliative care. Prospective studies are needed to establish the appropriate timing of the first palliative care consultation.
大多数姑息治疗和临终关怀的转诊发生在疾病进程的晚期，尽管早期干预可以减轻患者的症状困扰。本研究的目的是确定在我们的综合癌症中心被诊断为晚期癌症（aCA）的患者中，首次姑息治疗咨询（PC1）与死亡（D）之间的间隔，以及该间隔是否随时间增加。
研究组为在30个月期间进行首次姑息治疗咨询的2868例连续患者。我们查阅病历以获取有关人口统计学、癌症类型、癌症（CA）诊断日期、aCA诊断、PC1和D的信息。aCA被定义为局部复发或转移。
1404例患者（49%）为女性，1791例（62%）年龄小于65岁，2563例（89%）患有实体瘤，2004例（70%）为白人。PC1至D、aCA至PC1、aCA至D以及CA至D的中位间隔分别为42天、147天、250天和570天。实体瘤患者、年龄小于65岁的患者以及女性患者的PC1至D中位间隔更长（p < 0.0001、p = 0.002、p = 0.004）。PC1至D不受种族影响（p = 0.42）。连续5个半年的PC1至D中位间隔分别为46天、56天、42天、41天和34天（p = 0.02）。在此期间，PC1的数量从544例增加到654例（20%）。在5个半年期间，姑息治疗参与aCA至D阶段的比例（PC1至D/aCA至D）从0.30降至0.26（p = 0.0004）。
在我们中心，首次姑息治疗咨询至死亡的间隔随时间缩短。我们的转诊医生需要接受教育，以便更早地获得姑息治疗。需要进行前瞻性研究以确定首次姑息治疗咨询的合适时机。
