Division of Population Sciences (OOO, AMC, GAA), Center for Lymphoma (OOO, ASL), and Center for Leukemia (GAA), Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA; Ontario Institute for Cancer Research, Toronto, Canada (CCE).
J Natl Cancer Inst. 2015 Oct 5;108(1). doi: 10.1093/jnci/djv280. Print 2016 Jan.
Little is known about factors that influence hospice use for patients with blood cancers. We aimed to characterize hospice enrollment in a large population of patients with B-cell non-Hodgkin lymphoma (NHL) and assess the impact of disease characteristics such as aggressiveness and curability.
Using the Surveillance, Epidemiology, and End Results-Medicare database, we identified patients age 65 years and older who were diagnosed with indolent NHL, aggressive NHL, or mantle cell lymphoma (MCL, which is aggressive and incurable) and died between 1999 and 2009. We determined the prevalence of hospice use and predictors thereof, using multivariable logistic regression. All statistical tests were two-sided.
Of 18 777 patients, 9645 had indolent NHL, 8226 had aggressive NHL, and 906 had MCL. Of the total cohort, 41.6% enrolled in hospice, and 34.3% enrolled three or more days before death. Compared with patients with indolent NHL, those with MCL were more likely to enroll (adjusted odds ratio [AOR] = 1.72, 95% confidence interval [CI] = 1.49 to 1.98), followed by patients with aggressive NHL (AOR = 1.41, 95% CI = 1.32 to 1.50). Other factors statistically significantly associated with hospice use included older age, female sex, white race, high socioeconomic status, and later year of death.
In this large cohort of patients with lymphoma, hospice use was substantially lower than the national average for all cancers, suggesting either the need for improvement in enrollment or that the current hospice model is not meeting this population's end-of-life needs. Moreover, the fact that patients with MCL were most likely to enroll suggests that the end-of-life phase may be more easily determined in the context of cancers that are both aggressive and incurable.
对于影响血液癌症患者使用临终关怀的因素知之甚少。我们旨在描述大量 B 细胞非霍奇金淋巴瘤（NHL）患者的临终关怀入院情况，并评估疾病特征（如侵袭性和可治愈性）的影响。
我们使用监测、流行病学和最终结果-医疗保险数据库，确定了 1999 年至 2009 年间年龄在 65 岁及以上、被诊断为惰性 NHL、侵袭性 NHL 或套细胞淋巴瘤（MCL，侵袭性且不可治愈）且死亡的患者。我们使用多变量逻辑回归确定了临终关怀使用的流行率及其预测因素。所有统计检验均为双侧检验。
在 18777 名患者中，9645 名患有惰性 NHL，8226 名患有侵袭性 NHL，906 名患有 MCL。在总队列中，41.6%的患者入组临终关怀，34.3%的患者在死亡前三天或更晚入组。与惰性 NHL 患者相比，MCL 患者更有可能入组（调整后的优势比[OR] = 1.72，95%置信区间[CI] = 1.49 至 1.98），其次是侵袭性 NHL 患者（OR = 1.41，95% CI = 1.32 至 1.50）。与临终关怀使用相关的其他统计学显著因素包括年龄较大、女性、白种人、高社会经济地位和较晚的死亡年份。
在这个大型淋巴瘤患者队列中，临终关怀的使用率远低于所有癌症的全国平均水平，这表明要么需要改进入院率，要么当前的临终关怀模式不符合该人群的临终需求。此外，MCL 患者最有可能入组的事实表明，在侵袭性和不可治愈的癌症情况下，临终阶段可能更容易确定。
