Tokito Takaaki, Murakami Haruyasu, Mori Keita, Osaka Iwao, Takahashi Toshiaki
Division of Palliative Medicine, Shizuoka Cancer Center, Nagaizumi-cho Sunto-gun Division of Respirology, Neurology and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Fukuoka
Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-cho Sunto-gun.
Jpn J Clin Oncol. 2015 Mar;45(3):261-6. doi: 10.1093/jjco/hyu207. Epub 2014 Dec 5.
The American Society of Clinical Oncology published the goals of individualized care including advance care planning for advanced cancer patients in 2011. However, no data are available on the implementation status of advance care planning.
We retrospectively reviewed the electronic medical records and informed consent forms of consecutive Stage IV non-small cell lung cancer patients treated with chemotherapy between January 2010 and December 2012 at our institution. Two outcomes were defined to investigate the advance care planning implementation status: C-D, the duration from the last day of chemotherapy to death and D-D, that from the day of confirmed do-not-attempt-resuscitation order to death.
The study included 136 eligible patients. The advance care planning implementation status in participating patients was as follows: 96 (70%) patients received information on 'incurable disease before first-line chemotherapy', 69 (50%) were informed about 'supportive care before first-line chemotherapy', whereas 43 (32%) learned about their prognosis. The do-not-attempt-resuscitation decision was reflected in 29 patients' will (21%). The median C-D was 64 days. Receipt of ≤2 chemotherapy regimens and provision of prognosis information to patients were significantly associated with long C-D in multivariate analysis. The median D-D was 25 days. Provision of information on supportive care before first-line chemotherapy and provision of prognosis information to patients were significantly associated with long D-D in multivariate analysis.
Our results suggest that there is possible benefit from providing information on supportive care before first-line chemotherapy and informing patients about their prognosis in prolonging the duration of supportive care.
美国临床肿瘤学会于2011年公布了个体化医疗的目标，包括对晚期癌症患者进行预先医疗计划。然而，关于预先医疗计划的实施状况尚无可用数据。
我们回顾性分析了2010年1月至2012年12月在我院接受化疗的连续IV期非小细胞肺癌患者的电子病历和知情同意书。定义了两个结局以调查预先医疗计划的实施状况：C-D，从化疗最后一天至死亡的持续时间；D-D，从确认不进行心肺复苏医嘱之日至死亡的持续时间。
该研究纳入了136例符合条件的患者。参与研究患者的预先医疗计划实施状况如下：96例（70%）患者在一线化疗前收到了“无法治愈疾病”的信息，69例（50%）被告知“一线化疗前的支持性治疗”，而43例（32%）了解了其预后情况。29例患者（21%）的意愿中体现了不进行心肺复苏的决定。C-D的中位数为64天。在多因素分析中，接受≤2种化疗方案以及向患者提供预后信息与较长的C-D显著相关。D-D的中位数为25天。在多因素分析中，一线化疗前提供支持性治疗信息以及向患者提供预后信息与较长的D-D显著相关。
我们的结果表明，在一线化疗前提供支持性治疗信息并告知患者其预后情况可能有助于延长支持性治疗的持续时间。
