Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
J Pain Symptom Manage. 2013 Apr;45(4):726-34. doi: 10.1016/j.jpainsymman.2012.03.014. Epub 2012 Aug 30.
Understanding the longitudinal transitions of performance status among persons with cancer can assist providers in determining the appropriate time to initiate palliative care support.
To model longitudinal transitions of performance status in cancer outpatients, to determine the probabilities of improvement and deterioration in performance status over time, and to evaluate the factors associated with rates of transitions.
This population-based, retrospective, cohort study comprised adult outpatients diagnosed with any type of cancer and assessed for performance status throughout their observation period using the Palliative Performance Scale (PPS; scale 0-100; 0 indicates death). At every PPS assessment, patients were assigned to one of four states: stable state (PPS score 70-100), transitional state (PPS score 40-60), end-of-life state (PPS score 10-30), or dead. A Markov multistate model under the presence of interval censoring was used to examine the rate of state-to-state transitions.
There were 11,374 patients representing nearly 71,000 assessments. Patients with lung cancer in the transitional state had a 27.7% chance of being dead at the end of one month vs. 17.5% in patients with breast cancer. The average time spent in the transitional state was 6.6 weeks for patients diagnosed with gastrointestinal cancer vs. 8.8 weeks for patients with breast cancer. The rate at which one moves from the transitional state to death was higher for patients with lung cancer than those with breast cancer.
We estimated the probability and direction of change in performance status in cancer outpatients. Entry into the transitional state may serve as an indicator for referral for palliative care support. Mean end-of-life sojourn times are too short to allow meaningful integration of palliative care.
了解癌症患者的体能状态纵向变化有助于临床医生确定启动姑息治疗支持的适当时间。
建立癌症门诊患者体能状态的纵向转移模型，确定体能状态随时间改善和恶化的概率，并评估与转移率相关的因素。
这是一项基于人群的回顾性队列研究，纳入了所有类型癌症的成年门诊患者，使用姑息治疗体能状态量表（PPS；评分范围 0-100；0 表示死亡）评估其在整个观察期内的体能状态。在每次 PPS 评估时，患者被分为以下四种状态之一：稳定状态（PPS 评分 70-100）、过渡状态（PPS 评分 40-60）、终末期状态（PPS 评分 10-30）或死亡。在存在区间 censoring 的情况下，采用 Markov 多状态模型来评估状态间转移的速率。
共纳入 11374 例患者，代表了近 71000 次评估。在过渡状态的肺癌患者，一个月内死亡的概率为 27.7%，而乳腺癌患者为 17.5%。确诊为胃肠道癌症的患者在过渡状态下平均停留时间为 6.6 周，而乳腺癌患者为 8.8 周。从过渡状态转移到死亡的速度在肺癌患者中高于乳腺癌患者。
我们估计了癌症门诊患者体能状态变化的概率和方向。进入过渡状态可能是转诊姑息治疗支持的一个指标。终末期的停留时间太短，无法进行有意义的姑息治疗整合。
