Moth E B, Parry J, Stockler M R, Beale P, Blinman P, Della-Fiorentina S, Kiely B E
Concord Cancer Centre, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.
Macarthur Cancer Therapy Centre, Campbelltown Hospital, Sydney, New South Wales, Australia.
Intern Med J. 2015 Sep;45(9):909-15. doi: 10.1111/imj.12776.
Shared understanding of prognosis is vital for optimal, multidisciplinary, clinical decision making.
This study aims to determine the frequency and nature of prognostic information in medical oncologists' letters to referring doctors for patients with metastatic cancer.
We reviewed all consultation letters (to June 2014) for new patients with metastatic cancer presenting to medical oncologists at Concord and Macarthur Cancer Centres between June 2012 and June 2013. We recorded the presence and nature of prognostic information in the letters, patients' characteristics and survival. Characteristics associated with inclusion of prognostic information were explored.
We analysed 1344 letters pertaining to 272 patients with a median survival of 13 months. The median number of letters per patient was 4 (interquartile range 1-7), with 50% written by trainees. The terms 'metastatic' or 'stage IV cancer' were included in letters for 253 patients (93%), treatment was described as 'palliative' for 174 patients (64%) and the word 'incurable' was included for 93 (34%). Only 31 patients (11%) had a quantitative estimate of prognosis in any correspondence: median or average survival in 14, general time frame in 12 and, best case, typical and worst case scenarios in 5. Inclusion of quantitative prognostic information was not associated with patient age, cancer type, treatment plan, trainee authoring letter or shorter survival.
Inclusion of quantitative prognostic information in written correspondence from medical oncologists regarding patients with metastatic cancer was infrequent. Encouraging oncologists to include quantitative prognostic information in their letters could improve communication between oncologists, referring doctors and patients.
对预后的共同理解对于优化多学科临床决策至关重要。
本研究旨在确定肿瘤内科医生给转诊医生的关于转移性癌症患者信件中预后信息的频率和性质。
我们回顾了2012年6月至2013年6月期间在康科德癌症中心和麦克阿瑟癌症中心就诊的转移性癌症新患者的所有会诊信件（截至2014年6月）。我们记录了信件中预后信息的存在情况和性质、患者特征及生存情况。探讨了与包含预后信息相关的特征。
我们分析了1344封涉及272例患者的信件，这些患者的中位生存期为13个月。每位患者信件的中位数为4封（四分位间距为1 - 7），其中50%由实习医生撰写。253例患者（93%）的信件中包含“转移性”或“IV期癌症”字样，174例患者（64%）的信件中描述治疗为“姑息性”，93例患者（34%）的信件中包含“无法治愈”一词。在所有信件往来中，只有31例患者（11%）有预后的定量估计：14例提及中位或平均生存期，12例提及大致时间范围，5例提及最佳、典型和最差情况。包含定量预后信息与患者年龄、癌症类型、治疗方案、撰写信件的实习医生或较短生存期无关。
肿瘤内科医生给转移性癌症患者的书面信件中很少包含定量预后信息。鼓励肿瘤内科医生在信件中纳入定量预后信息可改善肿瘤内科医生、转诊医生和患者之间的沟通。
