Yennurajalingam Sriram, Lu Zhanni, Williams Janet L, Liu Diane D, Arthur Joseph Anthony, Bruera Eduardo
Department of Palliative,Rehabilitation, and Integrative Medicine,The University of Texas MD Anderson Cancer Center,Houston,Texas.
Department of Biostatistics,The University of Texas MD Anderson Cancer Center,Houston,Texas.
Palliat Support Care. 2017 Apr;15(2):197-204. doi: 10.1017/S1478951516000559. Epub 2016 Jul 22.
There is a limited number of pragmatic studies to evaluate the criteria for referral to outpatient palliative care. The aim of our study was to compare the characteristics, symptoms, and survival of patients with advanced non-small-cell lung cancer (NSCLC) referred (RF) versus not referred (NRF) to a novel embedded same-day rapid-access supportive care clinic (RASCC) and to compare the subgroups among referred patients.
We reviewed the medical records of all patients who received treatment at the thoracic oncology clinic for advanced non-small-cell lung cancer between August 1, 2012, and June 30, 2013, who were referred to the RASCC and those who were not referred. An oncology-estimated prognosis of ≤6 months and/or severe symptom distress was employed as criteria for referral to the RASCC.
Of 410 eligible patients, 155 (37.8%) were referred to the RASCC. RF patients had significantly higher patient-reported scores for pain, fatigue, lack of appetite, and symptom distress, as well as worse performance status and shorter survival than NRF patients. Among the RF patients, those who were referred early (≤3 months) had significantly worse symptom distress and shorter overall survival than patients who were referred later on. The patients treated by thoracic oncologists who referred a smaller proportion of their patients to the RASCC had significantly worse anxiety, well-being, spiritual pain, and symptom distress than patients treated by those who referred a larger proportion of their patients to the RASCC.
We found that patients who were referred to the RASCC had higher reported symptom distress and worse survival ratings. Further studies are needed to evaluate the optimal criteria for timely integration of palliative care and oncology care.
评估门诊姑息治疗转诊标准的实用性研究数量有限。我们研究的目的是比较转诊至新型嵌入式当日快速获得支持性护理诊所（RASCC）的晚期非小细胞肺癌（NSCLC）患者与未转诊患者的特征、症状和生存率，并比较转诊患者中的亚组情况。
我们回顾了2012年8月1日至2013年6月30日期间在胸科肿瘤门诊接受晚期非小细胞肺癌治疗的所有患者的病历，这些患者被转诊至RASCC或未被转诊。采用肿瘤学估计预后≤6个月和/或严重症状困扰作为转诊至RASCC的标准。
在410名符合条件的患者中，155名（37.8%）被转诊至RASCC。与未转诊患者相比，转诊患者在疼痛、疲劳、食欲不振和症状困扰方面的患者报告得分显著更高，功能状态更差，生存期更短。在转诊患者中，早期（≤3个月）转诊的患者症状困扰明显更严重，总生存期比后期转诊的患者更短。将较少比例患者转诊至RASCC的胸科肿瘤医生治疗的患者，其焦虑、幸福感、精神痛苦和症状困扰明显比将较大比例患者转诊至RASCC的医生治疗的患者更严重。
我们发现转诊至RASCC的患者报告的症状困扰更高，生存评分更差。需要进一步研究来评估姑息治疗与肿瘤治疗及时整合的最佳标准。
