Schulkes K J G, van Walree I C, van Elden L J R, van den Bos F, van Huis-Tanja L, Lammers J-W J, Ten Bokkel Huinink D, Hamaker M E
Department of Geriatric Medicine, Diakonessenhuis Utrecht, Utrecht, The Netherlands.
Department of Pulmonology, Diakonessenhuis Utrecht, Utrecht, The Netherlands.
Eur J Cancer Care (Engl). 2018 Mar;27(2):e12796. doi: 10.1111/ecc.12796. Epub 2017 Nov 16.
The quality of medical care delivered to patients with cancer near the end of life is a significant issue. Previous studies have defined several areas suggestive of aggressive cancer treatment as potentially representing poor quality care. The primary objective of current analysis was to examine chemotherapy and healthcare utilisation in the last 3 months of life among patients with cancer that received palliative chemotherapy. Patients were selected from the hospital administration database of the Diakonessenhuis Utrecht, the Netherlands. Data were extracted from the medical files. A total of 604 patients were included for analysis (median age: 64 years). For 300 patients (50%) chemotherapy was given in the last 3 months (CT+). For 76% (n = 229) of CT+ patients unplanned hospital admissions were made in these last 3 months, compared to 44% (n = 133) of CT- patients (p < .001). Visits to the emergency room in last 3 months were made by 67% (n = 202) of CT+ patients compared to 43% (n = 132) of CT- patients (p < .001). Healthcare consumption was significantly higher in patients who received chemotherapy in the last 3 months of life. Being able to inform our patients about these aspects of treatment can help to optimise both the quality of life and the quality of dying in patients with cancer.
为癌症末期患者提供的医疗服务质量是一个重大问题。先前的研究已经确定了几个提示积极癌症治疗的领域，这些领域可能代表着低质量的医疗服务。当前分析的主要目的是研究接受姑息化疗的癌症患者在生命的最后3个月内的化疗情况和医疗资源利用情况。患者选自荷兰乌得勒支迪亚科内森huis医院的管理数据库。数据从医疗档案中提取。共有604名患者纳入分析（中位年龄：64岁）。300名患者（50%）在最后3个月接受了化疗（CT+）。在最后3个月，CT+患者中有76%（n = 229）出现了非计划住院，而CT-患者中这一比例为44%（n = 133）（p <.001）。在最后3个月，CT+患者中有67%（n = 202）去过急诊室，而CT-患者中这一比例为43%（n = 132）（p <. .001）。在生命的最后3个月接受化疗的患者的医疗资源消耗显著更高。能够告知我们的患者治疗的这些方面有助于优化癌症患者的生活质量和死亡质量。
