Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK.
Cancer J. 2010 Sep-Oct;16(5):423-35. doi: 10.1097/PPO.0b013e3181f684e5.
Patients with advanced cancer experience a complex web of problems, all of which interact. Specialist palliative care services have developed to meet these needs, but their effectiveness should be considered. We sought to determine whether specialist palliative care teams achieve their aims and improve outcomes for patients with advanced cancer and their caregivers, in terms of improving symptoms and quality of life and/or reducing the emotional concerns of family caregivers. We conducted a systematic review, searching standard databases augmented by reference lists of earlier reviews. The review focused on specialist (ie, with trained and dedicated professionals) palliative care in the home, hospital, or designated inpatient settings for patients with cancer. Outcomes were pain, symptoms, quality of life, use of hospital services, and anxiety. Studies were excluded if they did not test specialist palliative care services. We identified 8 randomized controlled trials and 32 observational or quasi-experimental studies. Overall, the evidence demonstrated that home, hospital, and inpatient specialist palliative care significantly improved patient outcomes in the domains of pain and symptom control, anxiety, and reduced hospital admissions. The results suggest that specialist palliative care should be part of care for cancer patients. Although the appraisal of evidence found improvements across domains, there is a need to understand better the effects of different models of palliative care and to use standardized outcome measurement.
患有晚期癌症的患者会经历一系列复杂的问题，所有这些问题都会相互作用。专门的姑息治疗服务已经发展起来以满足这些需求，但应考虑其效果。我们旨在确定专门的姑息治疗团队是否能够实现其目标，并改善晚期癌症患者及其护理人员的结局，具体表现为改善症状和生活质量，和/或减轻家庭护理人员的情绪困扰。我们进行了系统评价，在标准数据库中进行搜索，并通过早期综述的参考文献列表进行补充。该综述重点关注针对癌症患者的居家、医院或指定住院环境中的专业（即有经过培训和专门从事的专业人员）姑息治疗。结局是疼痛、症状、生活质量、医院服务的使用和焦虑。如果研究未测试专业姑息治疗服务，则将其排除在外。我们确定了 8 项随机对照试验和 32 项观察性或准实验研究。总体而言，证据表明，居家、医院和住院专科姑息治疗在疼痛和症状控制、焦虑和减少住院治疗方面显著改善了患者的结局。结果表明，姑息治疗应该是癌症患者护理的一部分。尽管对证据的评估发现各个领域都有所改善，但仍需要更好地了解姑息治疗不同模式的效果，并使用标准化的结局测量。
