Doris A. Howell Palliative Care Service, Moores Cancer Center, University of California San Diego, La Jolla, California
Department of Radiation Medicine and Applied Science, Moores Cancer Center, University of California San Diego, La Jolla, California
J Natl Compr Canc Netw. 2016 Apr;14(4):439-45. doi: 10.6004/jnccn.2016.0050.
The role of palliative care has expanded over the past several decades, although the oncology-specific regional evolution of this specialty has not been characterized at the population-based level.
This study defined the patterns of palliative care delivery using a retrospective cohort of patients with advanced cancer within the SEER-Medicare linked database. We identified 83,022 patients with metastatic breast, prostate, lung, and colorectal cancers. We studied trends between 2000 through 2009, and determined patient-level and regional-level predictors of palliative care delivery.
Palliative care consultation rates increased from 3.0% in 2000 to 12.9% in 2009, with most consultations occurring in the last 4 weeks of life (77%) in the inpatient hospital setting. The rates of palliative care delivery were highest in the West (7.6%) and lowest in the South (3.2%). The likelihood of palliative care consultation increased with decreasing numbers of regional acute care hospital beds per capita. The use of palliative care consultation increased with increasing numbers of regional physicians. The use of palliative care decreased with increasing regional Medicare expenditure with a $1,387 difference per beneficiary between the first and fourth quartiles of palliative care use.
Geographic location influences a patient's options for palliative care in the United States. Although the overall rates of palliative care are increasing, future effort should focus on improving palliative care services in regions with the least access.
在过去的几十年中，姑息治疗的作用不断扩大，尽管在基于人群的水平上尚未描述肿瘤学专业的这一专业的具体区域演变。
本研究使用 SEER-Medicare 链接数据库中的晚期癌症患者的回顾性队列来定义姑息治疗的提供模式。我们确定了 83,022 例转移性乳腺癌，前列腺癌，肺癌和结肠癌患者。我们研究了 2000 年至 2009 年之间的趋势，并确定了姑息治疗提供的患者水平和区域水平的预测因素。
姑息治疗咨询率从 2000 年的 3.0％增加到 2009 年的 12.9％，大多数咨询发生在住院医院环境中生命的最后 4 周（77％）。西部地区（7.6％）的姑息治疗率最高，南部地区（3.2％）最低。人均区域急性护理医院床位数量减少，姑息治疗咨询的可能性增加。区域医生数量的增加与姑息治疗咨询的使用增加有关。姑息治疗的使用随着区域医疗保险支出的增加而减少，在姑息治疗使用的第一和第四四分位数之间，每位受益人的差异为 1,387 美元。
地理位置会影响美国患者选择姑息治疗的方式。尽管姑息治疗的总体比率在增加，但未来的工作重点应放在改善获得姑息治疗服务最少的地区的姑息治疗服务上。
