Creighton University School of Medicine, Division of Hematology/Oncology, University of Nebraska Medical Center, Division of Hematology/Oncology and Geriatric Medicine, Omaha, Nebraska, USA.
J Palliat Med. 2011 Nov;14(11):1231-5. doi: 10.1089/jpm.2011.0131. Epub 2011 Aug 30.
Cancer care near the end of life (EOL) has become more aggressive over the years. Palliative care services (PCS) may decrease this aggressive cancer care in terminally ill cancer patients. Our objective was to observe the aggressiveness of cancer care near the EOL among Veterans Affairs cancer patients before and after the institution of a PCS team. We also assessed the time taken prior to death to initiate a PCS consultation and its effect on the aggressiveness of cancer care near the EOL.
This is a retrospective chart review analysis performed at the local Veterans Affairs hospital looking at the last 100 patients in each of the years, 2002 and 2008, who died with active cancer. Only patients in 2008 had access to a PCS team.
In the last 30 days of life, compared to 2002, patients in 2008 had a higher incidence of: chemotherapy administration, more than one hospital admission, more than 14 days of hospital stay, intensive care unit admissions, and in-hospital deaths. Patients with timely PCS consults in 2008 appeared to have a lower incidence of: chemotherapy administration, more than one emergency department visit, more than one hospital admission, more than 14-day hospital stays, intensive care unit admissions, and deaths in the hospital. Timely PCS consults were associated with earlier and more frequent hospice referral.
Cancer care near the EOL has become more aggressive with time at one of the hospitals in the Veterans Affairs healthcare system (VAHS). Institution of a PCS service was unable to completely decrease this trend of increasing aggressiveness of cancer care near the EOL. However, timely PCS consults may help attenuate this aggressiveness.
近年来，生命末期（EOL）的癌症护理变得更加积极。姑息治疗服务（PCS）可能会减少绝症癌症患者的这种积极的癌症护理。我们的目的是观察在姑息治疗服务团队成立前后，退伍军人事务部癌症患者在 EOL 附近的癌症护理的积极性。我们还评估了在开始姑息治疗咨询之前花费的时间及其对 EOL 附近癌症护理积极性的影响。
这是在当地退伍军人事务医院进行的回顾性图表审查分析，研究了 2002 年和 2008 年每年最后 100 位患有活动性癌症的死亡患者。只有 2008 年的患者可以获得姑息治疗服务团队。
与 2002 年相比，2008 年患者在生命的最后 30 天内更有可能：接受化疗、一次以上住院、住院时间超过 14 天、入住重症监护病房和院内死亡。2008 年及时进行姑息治疗咨询的患者似乎不太可能：接受化疗、急诊就诊超过一次、一次以上住院、住院时间超过 14 天、入住重症监护病房和院内死亡。及时的姑息治疗咨询与更早和更频繁的临终关怀转诊相关。
在退伍军人事务医疗保健系统（VAHS）的一家医院中，随着时间的推移，EOL 附近的癌症护理变得更加积极。姑息治疗服务的建立并不能完全减少这种 EOL 附近癌症护理积极性增加的趋势。然而，及时的姑息治疗咨询可能有助于减轻这种积极性。
