Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts2Division of Population Sciences' Center for Outcomes and Policy Research, Dana-Farber Cancer Institute, Boston, Massachusetts.
Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena.
JAMA Oncol. 2015 Aug;1(5):592-600. doi: 10.1001/jamaoncol.2015.1953.
Cancer is the leading disease-related cause of death among adolescents and young adults (AYAs), but little is known about the care that AYA patients with cancer receive at the end of life (EOL).
To evaluate the intensity of EOL care among AYA patients with cancer.
DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional study of Kaiser Permanente Southern California (KSPC) cancer registry data and electronic health records for 663 AYA patients with either stage I to III cancer and evidence of cancer recurrence or stage IV cancer at diagnosis. All patients were treated within KSPC, an integrated health care delivery system, and died between 2001 and 2010 before age 40 years (age range at time of death, 15-39 years).
(1) Chemotherapy use in the last 14 days of life; (2) intensive care unit (ICU) care in the last 30 days of life; (3) more than 1 emergency department (ED) visit in the last 30 days of life; (4) hospitalization in the last 30 days of life; and (5) a composite measure of medically intensive EOL care including any of the aforementioned measures.
Eleven percent of patients (72 of 663) received chemotherapy within 14 days of death. In the last 30 days of life, 22% of patients (144 of 663) were admitted to the ICU; 22% (147 of 663) had more than 1 ED visit; and 62% (413 of 663) were hospitalized. Overall, 68% of patients (449 of 663) received at least 1 medically intensive EOL care measure.
Most AYA patients received at least 1 form of medically intensive EOL care. These findings suggest the need to better understand EOL care preferences and decision making in this young population.
癌症是青少年和年轻成年人（AYAs）中与疾病相关的主要死亡原因，但人们对临终关怀的了解甚少。
评估癌症青少年和年轻成年人（AYAs）患者临终关怀的强度。
设计、地点和参与者：横断面研究，使用 Kaiser Permanente Southern California（KSPC）癌症登记处的数据和电子健康记录，对 663 名患有 I 期至 III 期癌症且有癌症复发证据或诊断为 IV 期癌症的 AYA 患者进行评估。所有患者均在 KSPC 接受治疗，KSPC 是一个综合医疗服务提供系统，且在 40 岁之前（死亡时年龄范围为 15-39 岁）死于 2001 年至 2010 年期间。
（1）在生命的最后 14 天内使用化疗；（2）生命的最后 30 天内使用重症监护病房（ICU）护理；（3）在生命的最后 30 天内超过 1 次急诊就诊；（4）生命的最后 30 天内住院；（5）生命末期医疗密集护理的综合指标，包括上述任何一项措施。
11%的患者（663 例中的 72 例）在死亡前 14 天内接受了化疗。在生命的最后 30 天内，22%的患者（663 例中的 144 例）被收治入 ICU；22%的患者（663 例中的 147 例）有超过 1 次急诊就诊；62%的患者（663 例中的 413 例）住院治疗。总体而言，68%的患者（663 例中的 449 例）接受了至少 1 项医疗密集型临终关怀措施。
大多数 AYA 患者接受了至少 1 种形式的医疗密集型临终关怀。这些发现表明，需要更好地了解这一年轻人群的临终关怀偏好和决策。
