Huo Jinhai, Du Xianglin L, Lairson David R, Chan Wenyaw, Jiang Jing, Buchholz Thomas A, Guadagnolo B Ashleigh
Departments of *Radiation Oncology ∥Biostatistics, University of Texas MD Anderson Cancer Center Divisions of †Management, Policy and Community Health ‡Epidemiology, Human Genetics, and Environmental Sciences §Biostatistics, University of Texas School of Public Health, Houston, TX.
Am J Clin Oncol. 2015 Jun;38(3):235-41. doi: 10.1097/COC.0b013e31829378f9.
To examine the patterns of utilization of radiation therapy, chemotherapy, surgery, and hospice at the end-of-life care for patients diagnosed with metastatic melanoma.
We identified 816 Medicare beneficiaries toward who were 65 years of age or older, with pathologically confirmed metastatic malignant melanoma between January 1, 2000, and December 31, 2007. We evaluated trends and associations between sociodemographic and health service characteristics and the use of hospice care, chemotherapy, surgery, and radiation therapy.
We found increasing use of surgery for patients with metastatic melanoma from 13% in 2000 to 30% in 2007 (P=0.03 for trend), and no significant fluctuation in the use of chemotherapy (P=0.43) or radiation therapy (P=0.46). Older patients were less likely to receive radiation therapy or chemotherapy. The use of hospice care increased from 61% in 2000 to 79% in 2007 (P=0.07 for trend). Enrollment in short-term (1 to 3 d) hospice care use increased, whereas long-term hospice care (≥4 d) remained stable. Patients living in the SEER (Surveillance, Epidemiology and End Results) northeast and south regions were less likely to undergo surgery. Patients enrolled in long-term hospice care used significantly less chemotherapy, surgery, and radiation therapy.
Surgery and hospice care use increased over the years of this study, whereas the use of chemotherapy and radiation therapy remained consistent for patients diagnosed with metastatic melanoma.
研究转移性黑色素瘤患者临终关怀阶段放射治疗、化学治疗、手术治疗及临终关怀服务的使用模式。
我们确定了816名年龄在65岁及以上的医疗保险受益人，他们在2000年1月1日至2007年12月31日期间经病理确诊为转移性恶性黑色素瘤。我们评估了社会人口统计学和健康服务特征与临终关怀服务、化学治疗、手术治疗及放射治疗使用之间的趋势和关联。
我们发现转移性黑色素瘤患者接受手术治疗的比例从2000年的13%上升至2007年的30%（趋势P=0.03），化学治疗（P=0.43）或放射治疗的使用无显著波动（P=0.46）。老年患者接受放射治疗或化学治疗的可能性较小。临终关怀服务的使用从2000年的61%增至2007年的79%（趋势P=0.07）。短期（1至3天）临终关怀服务的使用增加，而长期临终关怀服务（≥4天）保持稳定。居住在监测、流行病学和最终结果（SEER）项目东北部和南部地区的患者接受手术的可能性较小。参加长期临终关怀服务的患者使用化学治疗、手术治疗和放射治疗的比例显著较低。
在本研究期间，手术治疗和临终关怀服务的使用有所增加，而转移性黑色素瘤患者化学治疗和放射治疗的使用保持稳定。
