Wang Jack P, Wu Chen-Yi, Hwang I-Hsuan, Kao Chien-Hui, Hung Yi-Ping, Hwang Shinn-Jang, Li Chung-Pin
Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, 11217, Taiwan.
National Yang-Ming University School of Medicine, Taipei, Taiwan.
BMC Palliat Care. 2016 Jan 8;15:1. doi: 10.1186/s12904-016-0075-x.
Inpatient palliative care is important for patients with terminal pancreatic cancer. However, the differences between inpatient palliative care and acute hospital care for inpatients with pancreatic cancer have not been explored in a population-based study.
This population-based nationwide study was conducted using data from the Taiwan National Health Insurance database to analyze the differences between inpatient palliative care and acute hospital care for inpatients with pancreatic cancer. We identified 854 patients with terminal pancreatic cancer, who had received in-hospital end-of-life care between January 2003 and December 2006. These patients were then sub-divided and matched 1:1 (using propensity score matching) according to whether they received inpatient palliative care (n = 276) or acute hospital care (n = 276). These groups were subsequently compared to evaluate any differences in the use of aggressive procedures, prescribed medications, and medical costs.
Inpatient palliative care was typically provided by family physicians (39%) and oncologists (25%), while acute hospital care was typically provided by oncologists (29%) and gastroenterologists (24%). The inpatient palliative care group used natural opium alkaloids significantly more frequently than the acute hospital care group (84.4% vs. 56.5%, respectively; P < 0.001). The inpatient palliative care group also had shorter hospital stays (10.6 ± 11.1 days vs. 20.6 ± 16.3 days, respectively; P < 0.001), fewer aggressive procedures, and lower medical costs (both, P < 0.005).
Compared to patients in acute hospital wards, patients with pancreatic cancer in inpatient palliative care units received more frequent pain control treatments, underwent fewer aggressive procedures, and incurred lower medical costs. Therefore, inpatient palliative care should be considered a viable option for patients with terminal pancreatic cancer.
住院姑息治疗对晚期胰腺癌患者很重要。然而，基于人群的研究尚未探讨住院姑息治疗与胰腺癌住院患者急性医院护理之间的差异。
这项基于人群的全国性研究使用台湾国民健康保险数据库的数据，分析住院姑息治疗与胰腺癌住院患者急性医院护理之间的差异。我们确定了854例晚期胰腺癌患者，他们在2003年1月至2006年12月期间接受了住院临终护理。然后根据这些患者是否接受住院姑息治疗（n = 276）或急性医院护理（n = 276）进行细分并1:1匹配（使用倾向评分匹配）。随后对这些组进行比较，以评估在积极治疗措施的使用、处方药物和医疗费用方面的任何差异。
住院姑息治疗通常由家庭医生（39%）和肿瘤学家（25%）提供，而急性医院护理通常由肿瘤学家（29%）和胃肠病学家（24%）提供。住院姑息治疗组使用天然鸦片生物碱的频率明显高于急性医院护理组（分别为84.4%和56.5%；P < 0.001）。住院姑息治疗组的住院时间也更短（分别为10.6 ± 11.1天和20.6 ± 16.3天；P < 0.001），积极治疗措施更少，医疗费用更低（均P < 0.005）。
与急性医院病房的患者相比，住院姑息治疗病房的胰腺癌患者接受疼痛控制治疗的频率更高，接受的积极治疗措施更少，医疗费用更低。因此，住院姑息治疗应被视为晚期胰腺癌患者的可行选择。
