Becerra Adan Z, Probst Christian P, Fleming Fergal J, Xu Zhaomin, Aquina Christopher T, Justiniano Carla F, Boodry Courtney I, Swanger Alex A, Noyes Katia, Katz Alan W, Monson John R, Jusko Todd A
1 Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA.
2 Surgical Health Outcomes & Research Enterprise, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA.
Am J Hosp Palliat Care. 2018 Feb;35(2):336-342. doi: 10.1177/1049909117706959. Epub 2017 May 11.
Although radiation therapy (RT) can provide palliative benefits for patients with metastatic rectal cancer, its role at the end of life remains unclear. The objective of this study was to assess sociodemographic and clinical factors associated with the use of RT during the last 30 days of life and to evaluate yearly time trends in RT utilization among stage IV patients with rectal cancer.
The 2004 to 2012 National Cancer DataBase was queried for patients with metastatic rectal cancer who had a documented death during follow-up. A Bayesian multilevel logistic regression model was used to characterize predictive factors and yearly time trends associated with RT use in the last 30 days of life.
Among 10 431 patients who met inclusion criteria, 345 (3%) received RT during the last 30 days of life. Factors independently associated with RT use included older age, female sex, African American race, nonprivate insurance, higher comorbidity burden, and worse grade. The odds of RT use at the end of life decreased by 28% between 2007 and 2009 (odds ratio [OR] = 0.72, 95% Credible Interval (CI) = 0.58-0.93), but then increased by 16% from 2010 to 2012 (OR = 1.16, 95% CI = 1.13-1.33), relative to 2004 to 2006.
Radiation therapy use for patients with metastatic rectal cancer is beneficial, and efforts to optimize its appropriate use are important. Several factors associated with RT use during the last 30 days of life included disparities in sociodemographic and clinical subgroups. Research is needed to understand the underlying causes of these inequalities and the role of predictive models in clinical decision-making.
尽管放射治疗（RT）可为转移性直肠癌患者提供姑息性益处，但其在生命终末期的作用仍不明确。本研究的目的是评估与生命最后30天内使用RT相关的社会人口统计学和临床因素，并评估IV期直肠癌患者RT使用的年度时间趋势。
查询2004年至2012年国家癌症数据库中在随访期间有记录死亡的转移性直肠癌患者。使用贝叶斯多级逻辑回归模型来描述与生命最后30天内使用RT相关的预测因素和年度时间趋势。
在10431名符合纳入标准的患者中，345名（3%）在生命的最后30天接受了RT。与RT使用独立相关的因素包括年龄较大、女性、非裔美国人种族、非私人保险、更高的合并症负担和更差的分级。与2004年至2006年相比，2007年至2009年生命终末期使用RT的几率下降了28%（优势比[OR]=0.72，95%可信区间[CI]=0.58-0.93），但随后在2010年至2012年增加了16%（OR=1.16，95%CI=1.13-1.33）。
对转移性直肠癌患者使用放射治疗是有益的，努力优化其合理使用很重要。在生命最后30天内与RT使用相关的几个因素包括社会人口统计学和临床亚组的差异。需要进行研究以了解这些不平等的根本原因以及预测模型在临床决策中的作用。
