Arvold Nils D, Wang Yun, Zigler Cory, Schrag Deborah, Dominici Francesca
Department of Radiation Oncology, Dana-Farber/Brigham & Women's Hospital, Boston, Massachusetts (N.D.A.); Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts (Y.W., C.Z., F.D.); Department of Medicine, Dana-Farber Cancer Institute, Boston, Massachusetts (D.S.).
Neuro Oncol. 2014 Nov;16(11):1530-40. doi: 10.1093/neuonc/nou060. Epub 2014 Apr 28.
Half of all glioblastoma patients are at least 65 years old. The frequency and duration of hospitalization from disease- and treatment-related morbidity in this population are unknown.
We performed a retrospective cohort study among patients aged 65 years and older with glioblastoma diagnosed between 1999 and 2007 using SEER-Medicare linked data. Diagnoses and procedures were identified using administrative claims data. Logistic regression was performed to identify predictors of high hospitalization burden.
Among the 5029 patients in the cohort, 52% were ages 65-74, and 52% were male. Twenty-six percent of patients underwent extensive resection, 72% received radiotherapy, and 18% received temozolomide. Median survival was 4.9 months. Among all patients, 21% were hospitalized at least 30 cumulative days between diagnosis and death, and 22% of all patients spent at least one-fourth of their remaining lives as inpatients. Higher comorbidity score (adjusted hazard ratio [AHR], 1.72; 95% CI, 1.42-2.07) and black race (AHR, 1.56; 95% CI, 1.11-2.18) were associated with an increased risk of being hospitalized for at least 25% of remaining life, whereas radiation (AHR, 0.49; 95% CI, 0.42-0.58), temozolomide (AHR, 0.31; 95% CI, 0.23-0.42), and extensive surgery (AHR, 0.83; 95% CI, 0.69-0.99) were associated with a decreased risk.
These data highlight the burden of hospitalization faced by a large proportion of older glioblastoma patients. In the setting of short survival, strategies to reduce the amount of time these patients spend hospitalized are urgently needed, to help maintain quality of life at the end of life.
所有胶质母细胞瘤患者中有一半年龄至少为65岁。该人群中因疾病和治疗相关发病率导致的住院频率和时长尚不清楚。
我们利用SEER - 医疗保险关联数据，对1999年至2007年间确诊的65岁及以上胶质母细胞瘤患者进行了一项回顾性队列研究。使用行政索赔数据确定诊断和治疗程序。进行逻辑回归以确定高住院负担的预测因素。
队列中的5029名患者中，52%年龄在65 - 74岁之间，52%为男性。26%的患者接受了广泛切除，72%接受了放疗，18%接受了替莫唑胺治疗。中位生存期为4.9个月。在所有患者中，21%在诊断至死亡期间累计住院至少30天，22%的患者在其剩余生命中至少四分之一的时间是住院患者。较高的合并症评分（调整后风险比[AHR]，1.72；95%置信区间，1.42 - 2.07）和黑人种族（AHR，1.56；95%置信区间，1.11 - 2.18）与剩余生命中至少25%的时间住院风险增加相关，而放疗（AHR，0.49；95%置信区间，0.42 - 0.58）、替莫唑胺（AHR，0.31；95%置信区间，0.23 - 0.42）和广泛手术（AHR，0.83；95%置信区间，0.69 - 0.99）与风险降低相关。
这些数据凸显了很大一部分老年胶质母细胞瘤患者面临的住院负担。在生存期较短的情况下，迫切需要采取策略减少这些患者的住院时间，以帮助维持生命末期的生活质量。
