Jefferson Palliative Care Service, Thomas Jefferson University, Department of Family & Community Medicine, Philadelphia, Pennsylvania 19107, USA.
J Palliat Med. 2010 Oct;13(10):1261-6. doi: 10.1089/jpm.2010.0057.
High symptom burden and hospital mortality among patients with lung cancer argues for early palliative care intervention. Patient characteristics and discharge dispositions in hospitalized patients with lung cancer receiving usual care were compared to those referred to a new palliative care service.
A retrospective database review of all lung cancer discharges receiving usual care (UC) and palliative care service (PCS) consultation was conducted. Demographics, length of stay, discharge disposition, and mortality were described and compared. Palliative Performance Scale scores were described according to discharge disposition in the PCS group. Disposition of all patients receiving either chemotherapy or surgery was also noted.
A total of 1476 hospital discharges with a diagnosis of lung cancer occurred between March 15, 2006 and June 30, 2009. Among all discharges, 9% received chemotherapy and 29% had surgery. The PCS was consulted for 8% of all lung cancer patients most commonly to address end-of-life-issues. PCS patients were more likely to be at the end-of-life than UC patients as evidenced by higher hospital mortality (31% versus 7%), higher intensive care (ICU) mortality (67% versus 16%) and more frequent discharge to hospice (41% versus 7%). PCS patients were hospitalized a median of 6 days before a referral was made. Hospitalization was significantly longer for PCS patients (M = 16.3 days, p < 0.001) than UC patients (M = 8.3 days).
In the first 3 years of a new palliative care initiative consults for lung cancer patients occurred late in the hospital stay or when death was imminent.
肺癌患者的高症状负担和医院死亡率表明需要早期进行姑息治疗干预。本研究比较了接受常规护理的住院肺癌患者的患者特征和出院转归与新的姑息治疗服务转介患者的特征和转归。
对所有接受常规护理（UC）和姑息治疗服务（PCS）咨询的住院肺癌患者的出院进行回顾性数据库审查。描述和比较了人口统计学、住院时间、出院转归和死亡率。还描述了 PCS 组中根据出院转归的姑息治疗表现量表评分。还记录了所有接受化疗或手术治疗的患者的转归情况。
2006 年 3 月 15 日至 2009 年 6 月 30 日期间，共有 1476 例诊断为肺癌的医院出院患者。在所有出院患者中，9%接受了化疗，29%接受了手术。PCS 咨询了 8%的所有肺癌患者，主要是为了解决临终问题。与 UC 患者相比，PCS 患者更接近生命末期，表现为更高的院内死亡率（31%对 7%）、更高的重症监护病房（ICU）死亡率（67%对 16%）和更频繁的临终关怀出院（41%对 7%）。PCS 患者在转介前平均住院 6 天。PCS 患者的住院时间明显长于 UC 患者（M=16.3 天，p<0.001）。
在新的姑息治疗倡议实施的头 3 年，对肺癌患者的咨询发生在住院晚期或死亡迫在眉睫时。
