Sharma Namita, Sharma Amit M, Wojtowycz Martha A, Wang Dongliang, Gajra Ajeet
SUNY Upstate University, Department of Medicine, Syracuse, NY 13210, USA; VA Medical Center, Syracuse, NY, USA.
SUNY Upstate University, Department of Public Health and Preventive Medicine, Syracuse, NY 13210, USA.
J Geriatr Oncol. 2016 Jan;7(1):39-46. doi: 10.1016/j.jgo.2015.12.004. Epub 2016 Jan 4.
There is a gap in knowledge regarding the rates of utilization of palliative care services (PCS) and acute care services (ACS) among older patients with advanced cancer close to end of life. We analyzed the utilization of these services among older adults (65 years and older) and compared them to those in younger adults (40-64 years) with advanced cancer.
A retrospective chart review of 567 veterans who died with advanced cancer between 2002 and 2009 and utilized PCS and ACS prior to death was conducted after IRB approval. To assess PCS utilization, we studied the mean duration between day of hospice referral and time of death (DOR) and the mean length of stay with hospice (LoS). The frequency of emergency room visits (ERVLM), hospital admissions (HALM), and ICU admissions (ICULM) in the last month of life was used as a measure for ACS. The differences among older and younger patients were compared using two sample t-tests.
Older adults had earlier referral to PCS [mean DOR: 47.3 versus 34.5 days, p=0.015], longer stay with hospice [mean LoS: 32.5 versus 20.2 days, p=0.007], fewer hospital [HALM: 0.7 versus 0.9, p=0.043], and ICU admissions [ICULM: 0.1 versus 0.2, p=0.030] per patient. The proportion of patients utilizing ER visits [53.5 % versus 59.5%, p=0.173] and hospital admissions [58.6% versus 65.1%, p=0.13] in the last month of life was similar in both age groups with fewer older adults utilizing ICU care [13.2% versus 19.5%, p=0.047].
Older patients with cancer are likely to be referred to PCS earlier than younger patients and spend a longer duration with PCS prior to death. However, there continues to be significant utilization of ACS in all patients with advanced cancer. Better understanding of the goals of care in older adults with cancer and education of oncology providers regarding the need to utilize and integrate palliative care services earlier in the course of disease is imperative.
在接近生命末期的老年晚期癌症患者中，关于姑息治疗服务（PCS）和急性护理服务（ACS）的利用率方面存在知识差距。我们分析了老年人（65岁及以上）中这些服务的利用率，并将其与年轻的晚期癌症成年人（40 - 64岁）进行比较。
在获得机构审查委员会（IRB）批准后，对2002年至2009年间死于晚期癌症且在死亡前使用过PCS和ACS的567名退伍军人进行了回顾性病历审查。为评估PCS的利用率，我们研究了临终关怀转诊日与死亡时间（DOR）之间的平均持续时间以及临终关怀的平均住院时间（LoS）。将生命最后一个月的急诊就诊频率（ERVLM）、住院次数（HALM）和重症监护病房（ICU）入住次数（ICULM）用作ACS的衡量指标。使用两样本t检验比较老年患者和年轻患者之间的差异。
老年人更早被转诊至PCS[平均DOR：47.3天对34.5天，p = 0.015]，临终关怀住院时间更长[平均LoS：32.5天对20.2天，p = 0.007]，每位患者的住院次数[HALM：0.7次对0.9次，p = 0.043]和ICU入住次数[ICULM：0.1次对0.2次，p = 0.030]更少。两个年龄组在生命最后一个月使用急诊就诊的患者比例[53.5%对59.5%，p = 0.173]和住院的患者比例[58.6%对65.1%，p = 0.13]相似，而使用ICU护理的老年人更少[13.2%对19.5%，p = 0.047]。
癌症老年患者比年轻患者更有可能更早被转诊至PCS，并且在死亡前接受PCS的时间更长。然而，所有晚期癌症患者对ACS的使用仍然显著。更好地理解癌症老年患者的护理目标，并对肿瘤学提供者进行关于在疾病过程中更早使用和整合姑息治疗服务必要性的教育势在必行。
