Oncology Centre, Addenbrooke's Hospital, Cambridge, UK.
Br J Cancer. 2013 Sep 17;109(6):1549-55. doi: 10.1038/bjc.2013.414. Epub 2013 Aug 29.
Care closer to home is being explored as a means of improving patient experience as well as efficiency in terms of cost savings. Evidence that community cancer services improve care quality and/or generate cost savings is currently limited. A randomised study was undertaken to compare delivery of cancer treatment in the hospital with two different community settings.
Ninety-seven patients being offered outpatient-based cancer treatment were randomised to treatment delivered in a hospital day unit, at the patient's home or in local general practice (GP) surgeries. The primary outcome was patient-perceived benefits, using the emotional function domain of the EORTC quality of life (QOL) QLQC30 questionnaire evaluated after 12 weeks. Secondary outcomes included additional QOL measures, patient satisfaction, safety and health economics.
There was no statistically significant QOL difference between treatment in the combined community locations relative to hospital (difference of -7.2, 95% confidence interval: -19·5 to +5·2, P=0.25). There was a significant difference between the two community locations in favour of home (+15·2, 1·3 to 29·1, P=0.033). Hospital anxiety and depression scale scores were consistent with the primary outcome measure. There was no evidence that community treatment compromised patient safety and no significant difference between treatment arms in terms of overall costs or Quality Adjusted Life Year. Seventy-eight percent of patients expressed satisfaction with their treatment whatever their location, whereas 57% of patients preferred future treatment to continue at the hospital, 81% at GP surgeries and 90% at home. Although initial pre-trial interviews revealed concerns among health-care professionals and some patients regarding community treatment, opinions were largely more favourable in post-trial interviews.
Patient QOL favours delivering cancer treatment in the home rather than GP surgeries. Nevertheless, both community settings were acceptable to and preferred by patients compared with hospital, were safe, with no detrimental impact on overall health-care costs.
为了提高患者体验并节省成本，正在探索在家中提供护理的方式。目前，有关社区癌症服务可改善护理质量和/或节省成本的证据有限。本研究采用随机方法比较了在医院和两种不同社区环境中提供癌症治疗的效果。
将 97 名接受门诊癌症治疗的患者随机分配至在医院日间病房、患者家中或当地全科医生（GP）手术室内接受治疗。主要结局是通过 EORTC QOL QLQC30 问卷的情绪功能领域评估，在 12 周后患者对自身获益的感知。次要结局包括额外的 QOL 测量指标、患者满意度、安全性和卫生经济学。
与医院治疗相比，联合社区环境中治疗的患者 QOL 无统计学差异（差值为-7.2，95%置信区间：-19.5 至 5.2，P=0.25）。与医院相比，两种社区环境之间存在显著差异，家庭环境更优（差值为+15.2，1.3 至 29.1，P=0.033）。医院焦虑和抑郁量表评分与主要结局测量指标一致。社区治疗并未降低患者安全性，并且在治疗组之间的总费用或健康调整生命年方面无显著差异。无论其治疗地点如何，78%的患者对其治疗表示满意，而 57%的患者希望未来在医院、81%的患者希望在 GP 手术室内、90%的患者希望在家中接受治疗。尽管初步试验访谈揭示了卫生保健专业人员和部分患者对社区治疗的担忧，但在试验后访谈中，大多数人对社区治疗的看法更为积极。
患者 QOL 倾向于在家中而不是在 GP 手术室内接受癌症治疗。尽管如此，与医院相比，两种社区环境都能被患者接受和选择，并且安全，对总体医疗成本没有不利影响。
