Lefkowits Carolyn, Teuteberg Winifred, Courtney-Brooks Madeleine, Sukumvanich Paniti, Ruskin Rachel, Kelley Joseph L
Department of Obstetrics, Gynecology & Reproductive Sciences, Division of Gynecologic Oncology, Magee-Womens Hospital of the University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
Department of Medicine, Division of General Internal Medicine, Section of Palliative Care & Medical Ethics, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
Gynecol Oncol. 2015 Mar;136(3):424-8. doi: 10.1016/j.ygyno.2014.12.030. Epub 2014 Dec 26.
The aim of this study is to evaluate the magnitude and time course of change in symptom burden after palliative care (PC) consultation in a cohort of gynecologic oncology inpatients.
Women with a gynecologic malignancy and PC consultation for symptom management between 3/1/12 and 2/28/13 were identified. Charts were reviewed for demographic and disease characteristics. Symptom scores on a modified Edmonton Symptom Assessment System (ESAS) scale were abstracted for pain, anorexia, fatigue, depression, anxiety, nausea and dyspnea. Prevalence of moderate-to-severe symptom intensity was compared between the day of PC consultation (D1), the day after PC consultation (D2) and the last recorded symptoms before discharge (DLast).
PC was consulted for symptom management during 129 admissions of 95 unique patients. Median age was 59, 84% were white and 67% had stage III/IV disease, with ovarian the most common site (52%). Symptom prevalence on D1 for at least mild intensity ranged 14% (dyspnea) to 80% (pain) and for at least moderate intensity from 3% (dyspnea) to 50% (pain). Statistically significant decreases in prevalence of moderate to severe symptom intensity between D1 and DLast occurred for pain, anorexia, fatigue and nausea (magnitude 58-66%) and between D1 and D2 for pain, fatigue and nausea (magnitude 50-55%). The majority of the improvement that occurred between D1 and DLast happened by D2.
PC consultation is associated with improvement in symptom burden, the majority of which occurs within one day of consultation. PC may be an effective tool for symptom management in patients with moderate to severe symptom intensity even during short hospitalizations and should be considered early in the hospitalization to effect timely symptom relief.
本研究旨在评估一组妇科肿瘤住院患者接受姑息治疗（PC）咨询后症状负担变化的程度和时间进程。
确定在2012年3月1日至2013年2月28日期间因症状管理而接受PC咨询的妇科恶性肿瘤女性患者。查阅病历以了解人口统计学和疾病特征。采用改良的埃德蒙顿症状评估系统（ESAS）量表提取疼痛、厌食、疲劳、抑郁、焦虑、恶心和呼吸困难的症状评分。比较姑息治疗咨询当天（D1）、咨询后一天（D2）和出院前最后记录症状时（DLast）中重度症状强度的患病率。
在95例不同患者的129次住院期间进行了症状管理的PC咨询。中位年龄为59岁，84%为白人，67%患有III/IV期疾病，最常见的部位是卵巢（52%）。D1时至少轻度强度症状的患病率为14%（呼吸困难）至80%（疼痛），至少中度强度症状的患病率为3%（呼吸困难）至50%（疼痛）。在D1和DLast之间，疼痛、厌食、疲劳和恶心的中重度症状强度患病率有统计学意义的下降（幅度为58 - 66%），在D1和D2之间，疼痛、疲劳和恶心的中重度症状强度患病率有统计学意义的下降（幅度为50 - 55%）。D1和DLast之间出现的大多数改善在D2时就已发生。
PC咨询与症状负担的改善相关，其中大部分改善发生在咨询后的一天内。即使在短期住院期间，PC对于中重度症状强度的患者可能是一种有效的症状管理工具，应在住院早期考虑使用以实现及时的症状缓解。
