Huang Huei-Kai, Hsieh Jyh-Gang, Hsieh Chia-Jung, Wang Ying-Wei
Department of Family Medicine, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.
School of Medicine, Tzu Chi University, Hualien, Taiwan.
Oncotarget. 2017 Jun 29;8(38):63596-63604. doi: 10.18632/oncotarget.18867. eCollection 2017 Sep 8.
Dementia is a progressive, incurable disease that can deprive patients of the ability to make decisions. This study determines whether dementia influences the medical care that a cancer patient receives at the end of life. We conducted a nationwide population-based cohort study on patients aged ≥20 with newly diagnosed cancer during 2000-2012. After matching to reduce confounders, there were 7,111 patients with and 28,444 without dementia. The adjusted odd ratios (OR) for medical interventions, including intensive care, palliative care, invasive procedures, and advanced diagnostic testing, were calculated for the final month and three months of life by a multiple logistic regression model. In the final month before death, the dementia cohort had longer hospital stays (17.7 vs. 17.1 days), more intensive care unit stays (OR = 1.32), and less palliative care (OR = 0.80) than the non-dementia cohort and were more likely to receive invasive procedures, including cardiopulmonary resuscitation (OR = 1.32), endotracheal intubation (OR = 1.27), mechanical ventilation (OR = 1.45), urinary catheterization (OR = 1.24), and feeding tube (OR = 1.88), but less likely to undergo chemotherapy (OR = 0.60) and diagnostic procedures such as computed tomography, magnetic resonance imaging, and sonography (OR = 0.87) or bone scan (OR = 0.69). The analysis examining the three months before death had similar results. In summary, patients with cancer and dementia are more likely to receive intensive care and invasive procedures but less likely to undergo advanced diagnostic testing, chemotherapy, or hospice care than those with cancer but without dementia.
痴呆症是一种渐进性、无法治愈的疾病，会使患者丧失决策能力。本研究旨在确定痴呆症是否会影响癌症患者临终时接受的医疗护理。我们对2000年至2012年期间年龄≥20岁的新诊断癌症患者进行了一项全国性的基于人群的队列研究。在进行匹配以减少混杂因素后，有7111名患有痴呆症的患者和28444名未患痴呆症的患者。通过多因素逻辑回归模型计算了生命最后一个月和最后三个月医疗干预措施的调整比值比（OR），这些干预措施包括重症监护、姑息治疗、侵入性操作和高级诊断检查。在死亡前的最后一个月，与非痴呆症队列相比，痴呆症队列的住院时间更长（17.7天对17.1天），重症监护病房住院时间更多（OR = 1.32），姑息治疗更少（OR = 0.80），并且更有可能接受侵入性操作，包括心肺复苏（OR = 1.32）、气管插管（OR = 1.27）、机械通气（OR = 1.45）、导尿（OR = 1.24）和鼻饲管（OR = 1.88），但接受化疗的可能性较小（OR = 0.60），接受计算机断层扫描、磁共振成像和超声等诊断检查（OR = 0.87）或骨扫描（OR = 0.69）的可能性也较小。对死亡前三个月的分析结果相似。总之，与患有癌症但没有痴呆症的患者相比，患有癌症和痴呆症的患者更有可能接受重症监护和侵入性操作，但接受高级诊断检查、化疗或临终关怀的可能性较小。
