Department of Nursing, Tom Baker Cancer Centre, Alberta Health Services Cancer Care, Calgary, Canada.
Support Care Cancer. 2013 Dec;21(12):3379-86. doi: 10.1007/s00520-013-1917-1. Epub 2013 Aug 10.
A new ambulatory consultative clinic with integrated assessments by palliative care, radiation oncology, and allied health professionals was introduced to (1) assess patients with brain metastases at a regional comprehensive cancer center and (2) inform and guide patients on management strategies, including palliative radiotherapy, symptom control, and end-of-life care issues. We conducted a quality assurance study to inform clinical program development.
Between January 2011 and May 2012, 100 consecutive brain metastases patients referred and assessed through a multidisciplinary clinic were evaluated for baseline characteristics, radiotherapy use, and supportive care decisions. Overall survival was examined by known prognostic groups. Proportion of patients receiving end-of-life radiotherapy (death within 30 and 14 days of brain radiotherapy) was used as a quality metric.
The median age was 65 years, with non-small cell lung cancer (n = 38) and breast cancer (n = 23) being the most common primary cancers. At least 57 patients were engaged in advance care planning discussions at first consult visit. In total, 75 patients eventually underwent brain radiotherapy, whereas 25 did not. The most common reasons for nonradiotherapy management were patient preference and rapid clinical deterioration. Overall survival for prognostic subgroups was consistent with literature reports. End-of-life brain radiotherapy was observed in 9 % (death within 30 days) and 1 % (within 14 days) of treated patients.
By integrating palliative care expertise to address the complex needs of patients with newly diagnosed brain metastases, end-of-life radiotherapy use appears acceptable and improved over historical rates at our institution. An appreciable proportion of patients are not suitable for palliative brain radiotherapy or opt against this treatment option, but the team approach involving nurses, palliative care experts, allied health, and clinical oncologists facilitates patient-centered decision making and transition to end-of-life care.
在一家区域综合癌症中心，引入了一个新的门诊咨询诊所，由姑息治疗、放射肿瘤学和相关医疗专业人员进行综合评估，旨在：(1)评估脑转移患者，(2)告知并指导患者管理策略，包括姑息性放疗、症状控制和临终关怀问题。我们进行了一项质量保证研究，为临床项目的发展提供信息。
2011 年 1 月至 2012 年 5 月，通过多学科诊所转诊和评估的 100 例脑转移患者，对其基线特征、放疗应用和支持性护理决策进行了评估。根据已知的预后分组来评估总生存期。将临终期放疗的患者比例（脑放疗后 30 天和 14 天内死亡）作为质量指标。
中位年龄为 65 岁，非小细胞肺癌（n=38）和乳腺癌（n=23）是最常见的原发癌。至少有 57 例患者在首次就诊时就开始了预先护理计划的讨论。最终，75 例患者接受了脑部放疗，25 例患者未接受。非放疗管理最常见的原因是患者的偏好和快速的临床恶化。预后亚组的总体生存率与文献报告一致。在接受治疗的患者中，有 9%（放疗后 30 天内死亡）和 1%（放疗后 14 天内死亡）的患者接受了临终期脑部放疗。
通过整合姑息治疗专业知识，来满足新诊断为脑转移患者的复杂需求，临终期放疗的应用似乎是可以接受的，并且在我们机构中的使用比例高于历史水平。相当一部分患者不适合进行姑息性脑放疗，或者选择不接受这种治疗方法，但护士、姑息治疗专家、相关医疗和临床肿瘤学家的团队方法，促进了以患者为中心的决策制定和向临终关怀的过渡。
