Heinonen T, Loimu V, Saarilahti K, Saarto T, Mäkitie A
Comprehensive Cancer Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Department of Otorhinolaryngology, Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, P.O. Box 263, FI-00029, Helsinki, Finland.
Eur Arch Otorhinolaryngol. 2018 Feb;275(2):545-551. doi: 10.1007/s00405-017-4843-x. Epub 2017 Dec 15.
Studies on palliative care of head and neck cancer (HNC) patients are scarce although the affected patient population is quite large.
To evaluate the role of a specialised palliative-care pathway of HNC patients.
Data on all HNC patients who were treated at the Helsinki University Hospital Palliative Care Center during 1 year were retrospectively reviewed. The analysis comprised 60 patients (49 males; mean age 67 years; range 28-88). All patients had a minimum follow-up of 1 year or until death.
Fifty-nine (98%) out of the 60 patients died during the follow-up period. Median survival after diagnosis was 11 months (range 3 weeks-11.9 years) and after withholding disease-specific therapies 3 months (range 0-16). Thirty-three (55%) patients received palliative radiotherapy, 27 (45%) had PEG tube and 17 (28%) tracheostomy. Thirty-seven (66%) patients visited an emergency department (ED) (median 1.3 visits; range 0-6) and 21 (35%) were hospitalised at the university hospital during the palliative period. The most common severe complications were infection (also the most common reason for ED visits and hospitalisation), bleeding (four massive airway bleedings with one death), delirium and airway obstruction (one emergency tracheostomy). Twelve (35%) out of the 34 patients who were referred to specialised home care died at home as compared with three (12%) out of the 26 patients not supported by a specialised home-care team.
Severe complications leading to an emergency unit visit and hospitalisation are common among HNC patients in their relatively short palliative period reflecting the need for early-integrated palliative care. Collaboration with a specialised palliative home-care team seems to increase end-of-life care at home.
尽管头颈癌（HNC）患者群体规模较大，但针对该群体姑息治疗的研究却很匮乏。
评估针对HNC患者的专业姑息治疗路径的作用。
对赫尔辛基大学医院姑息治疗中心1年内收治的所有HNC患者的数据进行回顾性分析。分析纳入60例患者（49例男性；平均年龄67岁；范围28 - 88岁）。所有患者的最短随访期为1年或直至死亡。
60例患者中有59例（98%）在随访期内死亡。诊断后的中位生存期为11个月（范围3周 - 11.9年），停止针对疾病的治疗后的中位生存期为3个月（范围0 - 16个月）。33例（55%）患者接受了姑息性放疗，27例（45%）患者置入了经皮内镜下胃造口术（PEG）管，17例（28%）患者进行了气管切开术。37例（66%）患者前往急诊科就诊（中位就诊次数1.3次；范围0 - 6次），21例（35%）患者在姑息治疗期间入住大学医院。最常见的严重并发症为感染（也是前往急诊科就诊和住院的最常见原因）、出血（4例大出血致气道出血，1例死亡）、谵妄和气道梗阻（1例行急诊气管切开术）。34例被转介至专业居家护理的患者中有12例（35%）在家中死亡，而26例未得到专业居家护理团队支持的患者中有3例（12%）在家中死亡。
在相对较短的姑息治疗期内，导致患者前往急诊室就诊和住院的严重并发症在HNC患者中很常见，这反映了早期整合姑息治疗的必要性。与专业姑息居家护理团队合作似乎能增加在家中接受临终关怀的比例。
