Currow David C, Clark Katherine, Kamal Arif, Collier Aileen, Agar Meera R, Lovell Melanie R, Phillips Jane L, Ritchie Christine
1Discipline, Palliative, and Supportive Services, Flinders University, Bedford Park, South Australia.
2Southern Adelaide Palliative Services, Repatriation General Hospital, Daw Park, South Australia.
J Palliat Med. 2015 Jun;18(6):480-5. doi: 10.1089/jpm.2014.0444. Epub 2015 Apr 10.
Many people in our communities live with symptoms for years or decades, something of relevance to hospice/palliative care clinicians and researchers. The proportion of people in the community at large who have a chronic symptom is likely to approximate the proportion of people referred to hospice/palliative care services with that same chronic symptom that pre-dates their life-limiting illness. Such patients may have different responsiveness to, and expectations from, symptomatic therapies, thus requiring more advanced approaches to symptom control. For researchers evaluating the impact of hospice/palliative care services, failing to account for people with long-term refractory symptoms pre-dating their life-limiting illness may systematically underestimate services' benefits. Observational symptom prevalence studies reported in hospice/palliative care to date have not accounted for people with long-term refractory symptoms, potentially systematically overestimating symptoms attributed to life-limiting illnesses. Cross-sectional community prevalence rates of key chronic refractory symptoms largely unrelated to their life-limiting illness reflect the likely prevalence on referral to hospice/palliative care: fatigue (up to 35%); pain (12%-31%); pain with neuropathic characteristics (9%); constipation (2%-29%); dyspnea (4%-9%); cognitive impairment (>10% of people >65 years old; >30% of people >85 years old); anxiety (4%); and depression (lifetime incidence 2%-15%; one year prevalence 3%). Prospective research is needed to establish (1) the prevalence and severity of chronic symptoms that pre-date the diagnosis of a life-limiting illness in people referred to hospice/palliative care services, comparing this to whole-of-population estimates; and (2) whether this group is disproportionately represented in people with refractory symptoms.
我们社区中的许多人多年甚至数十年来一直忍受着症状的折磨，这对临终关怀/姑息治疗的临床医生和研究人员而言意义重大。在整个社区中，患有慢性症状的人群比例可能与因同样的慢性症状而在其生命受限疾病之前就被转介至临终关怀/姑息治疗服务机构的人群比例相近。这类患者对症状性治疗的反应和期望可能有所不同，因此需要更先进的症状控制方法。对于评估临终关怀/姑息治疗服务影响的研究人员来说，若未能将在生命受限疾病之前就患有长期难治性症状的人群纳入考量，可能会系统性地低估服务的益处。迄今为止，临终关怀/姑息治疗领域所报告的观察性症状患病率研究并未将患有长期难治性症状的人群纳入考虑，这可能会系统性地高估归因于生命受限疾病的症状。与生命受限疾病基本无关的关键慢性难治性症状的横断面社区患病率反映了转介至临终关怀/姑息治疗服务机构时可能的患病率：疲劳（高达35%）；疼痛（12% - 31%）；具有神经病理性特征的疼痛（9%）；便秘（2% - 29%）；呼吸困难（4% - 9%）；认知障碍（65岁以上人群中超过10%；85岁以上人群中超过30%）；焦虑（4%）；以及抑郁（终生发病率2% - 15%；一年患病率3%）。需要开展前瞻性研究以确定：（1）在被转介至临终关怀/姑息治疗服务机构的人群中，在生命受限疾病诊断之前就存在的慢性症状的患病率和严重程度，并将其与总体人群估计值进行比较；以及（2）这一群体在难治性症状患者中所占比例是否过高。
