University of Wisconsin, Carbone Cancer Center, Hematology/Oncology, K6/518, 600 Highland Ave, Madison, WI 53729, USA.
J Oncol Pract. 2013 Jan;9(1):51-4. doi: 10.1200/JOP.2012.000698.
Despite advances in the care of patients with cancer over the last 10 years, cancer remains the second leading cause of death in the United States. Many patients receive aggressive, in-hospital end-of-life care at high cost. There are few data on outcomes after unplanned hospitalization of patients with metastatic cancer.
In 2000 and 2010, data were collected on admissions, interventions, and survival for patients admitted to an academic inpatient medical oncology service.
The 2000 survey included 191 admissions of 151 unique patients. The 2010 survey assessed 149 admissions of 119 patients. Lung, GI, and breast cancers were the most common cancer diagnoses. In the 2010 assessment, pain was the most common chief complaint, accounting for 28%. Although symptoms were the dominant reason for admission in 2010, procedures and imaging were common in both surveys. The median survival of patients after discharge was 4.7 months in 2000 and 3.4 months in 2010. Despite poor survival in this patient population, hospice was recommended in only 23% and 24% of patients in 2000 and 2010, respectively. Seventy percent of patients were discharged home without additional services.
On the basis of our data, an unscheduled hospitalization for a patient with advanced cancer strongly predicts a median survival of fewer than 6 months. We believe that hospital admission represents an opportunity to commence and/or consolidate appropriate palliative care services and end-of-life care.
尽管在过去 10 年中癌症患者的治疗取得了进展，但癌症仍然是美国第二大致死原因。许多患者在高成本的情况下接受积极的院内临终关怀。关于转移性癌症患者非计划性住院后的结局数据很少。
2000 年和 2010 年，我们收集了在学术住院内科肿瘤病房住院的患者的入院、干预和生存数据。
2000 年的调查包括 191 例 151 名患者的入院，2010 年的调查评估了 149 例 119 名患者的入院。肺癌、胃肠道癌和乳腺癌是最常见的癌症诊断。在 2010 年的评估中，疼痛是最常见的主要主诉，占 28%。尽管症状是 2010 年入院的主要原因，但在两次调查中，操作和影像学检查都很常见。出院后患者的中位生存时间为 2000 年的 4.7 个月和 2010 年的 3.4 个月。尽管该患者人群的生存预后较差，但在 2000 年和 2010 年，分别只有 23%和 24%的患者被建议接受临终关怀，出院后 70%的患者未接受其他服务而直接回家。
根据我们的数据，晚期癌症患者的非计划性住院强烈预示着中位生存时间不到 6 个月。我们认为，住院治疗提供了一个开始和/或巩固适当的姑息治疗服务和临终关怀的机会。
