School of Health Sciences and Social Work, Växjö University, Växjö, Sweden.
Acta Oncol. 2010 May;49(4):460-6. doi: 10.3109/02841860903463991.
Palliative cancer care in acute hospitals is scarcely studied. We therefore described and compared symptoms, care needs and types of cancer sites in 2002 compared to 2007 and analysed the relationships between these factors.
The study was population-based with a cross-sectional design and was carried out in medical, surgical and oncology wards in two acute care hospitals with no advanced palliative home care service. In 2002, 82 one-day-inventories were done (1 352 patients) compared to 142 one-day-inventories in 2007 (2 972 patients). Symptoms, care needs and cancer site were registered according to a questionnaire. Multiple logistic regression models were used to analyse associations between symptoms, care needs and cancer site.
The proportion of palliative cancer patients had decreased during a five year period (14% vs. 11%, p<0.01). The patients were older in 2007 (74 vs. 70 years, p<0.001) and had more symptoms and care needs per patient (2.6 vs. 1.6, p<0.001). The most common symptoms were pain and deterioration and the most common cancer sites were prostate and colorectal cancer in both samples. Associations between symptoms, care needs and cancer site were mostly weak. Deterioration was associated with colorectal cancer, whereas pain was not associated with any specific cancer site. In haematological malignancies there was a high occurrence of infections and a high need of blood transfusions and infusions. Stomach/oesophagus cancers were significantly associated with nausea, nutritional problems and need of infusions while unknown primary malignancies were associated with abdominal surgery and infusions.
Although we do not know all the causes for hospitalization, this study indicates that more focus should be on the symptoms instead of the specific cancer diagnosis. The findings also indicate that many palliative cancer patients' problems would be suitable for advanced palliative home care instead of acute hospital care.
急性医院中的癌症姑息治疗研究甚少。因此，我们描述并比较了 2002 年和 2007 年的症状、护理需求和癌症部位，并分析了这些因素之间的关系。
本研究为基于人群的横断面设计，在两家无高级姑息治疗家庭护理服务的急性护理医院的内科、外科和肿瘤科病房进行。2002 年进行了 82 项为期一天的调查（1352 例患者），而 2007 年进行了 142 项为期一天的调查（2972 例患者）。根据问卷登记症状、护理需求和癌症部位。采用多逻辑回归模型分析症状、护理需求和癌症部位之间的关联。
在五年期间，姑息治疗癌症患者的比例下降（14%比 11%，p<0.01）。2007 年的患者年龄更大（74 岁比 70 岁，p<0.001），每位患者的症状和护理需求更多（2.6 比 1.6，p<0.001）。最常见的症状是疼痛和恶化，最常见的癌症部位是前列腺癌和结直肠癌，这两个样本均如此。症状、护理需求和癌症部位之间的关联大多较弱。恶化与结直肠癌相关，而疼痛与任何特定的癌症部位无关。在血液恶性肿瘤中，感染和输血和输液的需求很高。胃/食道癌与恶心、营养问题和输液需求显著相关，而原发灶不明的恶性肿瘤与腹部手术和输液相关。
尽管我们不知道所有住院的原因，但本研究表明，应该更加关注症状而不是特定的癌症诊断。这些发现还表明，许多姑息治疗癌症患者的问题适合高级姑息治疗家庭护理，而不是急性医院护理。
