Mayo Clinic, Rochester, MN.
J Oncol Pract. 2011 Jan;7(1):48-53. doi: 10.1200/JOP.2010.000067.
We sought to characterize the aggregate features and survival of patients who receive inpatient palliative care consultation, particularly focusing on patients with cancer, to identify opportunities to improve clinical outcomes.
We reviewed prospectively collected data on patients seen by the Palliative Care Inpatient Consult Service at Mayo Clinic (Rochester, MN) from January 2003 to September 2008. Demographics, consultation characteristics, and survival were analyzed using Kaplan-Meier survival curves and Cox survival models.
Cancer was the most common primary diagnosis (47%) in the 1,794 patients seen over the 5-year period. A significant growth in the annual number of palliative care consultations has been observed (113 in 2003 v 414 in 2007), despite stable total hospital admissions. Frequently encountered reasons for consultation included clarification of care goals (29%), assistance with dismissal planning (19%), and pain control (17%). Although patients with cancer had the highest median survival after consultation in this cohort versus patients with other diagnoses, we observed a 5-year trend of decreasing survival from admission to death and from consultation to death. Median time from admission to death for patients with cancer was 36 days in 2003 and only 19 days in 2008 (P < .01). Median time from consultation to death decreased from 33 days in 2003 to only 11.5 days in 2008 (P < .01).
Patients with cancer often have complex needs that must be met within a short window for intervention. We highlight opportunities for improved multidisciplinary care for patients with advanced cancer and their families, including opportunity for earlier palliative care involvement, even in the outpatient setting.
我们旨在描述接受住院姑息治疗咨询的患者的总体特征和生存情况，尤其侧重于癌症患者，以确定改善临床结局的机会。
我们回顾了 2003 年 1 月至 2008 年 9 月 Mayo 诊所（明尼苏达州罗切斯特）姑息治疗住院咨询服务的前瞻性收集数据。使用 Kaplan-Meier 生存曲线和 Cox 生存模型分析人口统计学、咨询特征和生存情况。
在 5 年期间观察到的 1794 名患者中，癌症是最常见的主要诊断（47%）。尽管总住院人数稳定，但姑息治疗咨询的年数量显著增加（2003 年为 113 次，2007 年为 414 次）。常见的咨询原因包括明确治疗目标（29%）、协助离职计划（19%）和疼痛控制（17%）。尽管在本队列中，与其他诊断的患者相比，癌症患者在咨询后具有最高的中位生存时间，但我们观察到从入院到死亡以及从咨询到死亡的 5 年趋势是生存时间逐渐缩短。在 2003 年，癌症患者从入院到死亡的中位时间为 36 天，而在 2008 年仅为 19 天（P <.01）。从咨询到死亡的中位时间从 2003 年的 33 天缩短至 2008 年的仅 11.5 天（P <.01）。
癌症患者通常有复杂的需求，这些需求必须在短时间内得到满足。我们强调了为晚期癌症患者及其家属提供改进的多学科护理的机会，包括为患者提供更早的姑息治疗参与机会，甚至在门诊环境中。
