Brooks David, Hughes Philippa, Farrington Clare, Bath Peter A, McGregor Mary, Ahmed Wasim, Noble Bill
c Chesterfield Royal Hospital NHS Foundation Trust , Chesterfield , UK.
a Academic Unit of Supportive Care, School of Medicine and Biomedical Sciences , University of Sheffield , Sheffield , UK.
Hosp Pract (1995). 2018 Feb;46(1):37-42. doi: 10.1080/21548331.2018.1418140. Epub 2018 Jan 12.
Cancer of unknown primary is the fourth most common cause of cancer death in the United Kingdom. National guidance in 2010 recommended the establishment of a dedicated unknown primary team to facilitate targeted investigation and symptom control. A service development project was undertaken to identify those affected by malignancy of unknown origin and institute a pathway for coordinating their care led by a palliative physician.
In order to describe the patient population and illness trajectory and to assess the effect of the new pathway on the clinical outcomes we used a retrospective and prospective comparative case notes survey to identify the pre- and post-pathway population. This took place in secondary care. Inclusion criteria were patients with metastatic disease with no known primary; exclusion criteria were where the site of metastasis was so suggestive of a primary that it would be managed as per that disease process. 88 patients were included.
Mean age was 72.5 years. The mean survival time from presentation was 81.8 days. There was no difference pre or during pathway implementation in age, performance status or survival time. There was no reduction in the numbers referred for tumour directed therapy. There was a non-statistically significant reduction in the number who died in hospital during the pathway implementation.
This study suggests having a metastatic malignancy of unknown primary origin service led by a palliative physician does not reduce the number referred for tumour directed therapy. It also adds evidence of the poor prognosis and thus the need for early palliative care input.
原发性不明癌症是英国癌症死亡的第四大常见原因。2010年的国家指南建议设立一个专门的原发性不明癌症团队，以促进有针对性的调查和症状控制。开展了一个服务开发项目，以识别那些受不明原发恶性肿瘤影响的患者，并制定一条由姑息治疗医生主导的协调其护理的途径。
为了描述患者群体和疾病轨迹，并评估新途径对临床结果的影响，我们采用回顾性和前瞻性比较病例记录调查来识别途径实施前后的患者群体。该调查在二级医疗保健机构进行。纳入标准为患有转移性疾病且原发灶不明的患者；排除标准为转移部位高度提示原发灶，应按照该疾病进程进行处理的患者。共纳入88例患者。
平均年龄为72.5岁。从就诊到死亡的平均生存时间为81.8天。在途径实施前或实施期间，患者的年龄、体能状态或生存时间没有差异。接受肿瘤导向治疗的转诊人数没有减少。在途径实施期间，在医院死亡的人数有非统计学意义的减少。
本研究表明，由姑息治疗医生主导的原发性不明转移恶性肿瘤服务并不能减少接受肿瘤导向治疗的转诊人数。这也进一步证明了预后较差，因此需要早期姑息治疗干预。
