1 Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center , Houston, Texas.
2 Division of Geriatrics and Palliative Medicine, The University of Texas Health Science Center at Houston , McGovern Medical School, Harris Health System, Lyndon B. Johnson Hospital, Houston, Texas.
J Palliat Med. 2018 May;21(5):678-685. doi: 10.1089/jpm.2017.0236. Epub 2018 Feb 16.
Patients with advanced cancer experience severe physical, psychosocial, and spiritual distress requiring palliative care (PC). There are limited literature regarding characteristics and outcomes of patients evaluated by PC services at public hospitals (PHs). Objective, Design, Setting/Subjects, and Measurements: To compare the outcomes of advanced cancer patients undergoing PC at a PH and those at a comprehensive cancer center (CCC). We reviewed 359 consecutive advanced cancer patients (PH, 180; CCC, 179) undergoing PC. Symptoms and outcomes at consultation and first follow-up visit were assessed. Summary statistics were used to describe patient characteristics and outcomes.
The PH and CCC patients differed significantly according to race: 23% white, 39% black, and 36% Hispanic patients at the PH versus 66% white, 17% black, and 11% Hispanic patients at the CCC (p < 0.0001). Ninety-six (53%) patients at PH and 178 (99%) at the CCC had health insurance (p < 0.0001). Symptoms at consultation at PH and CCC were pain (85% and 91%, respectively; p = 0.0639), fatigue (81% and 94%, respectively; p = 0.0003), depression (51% and 69%, respectively; p = 0.0013), anxiety (47% and 75%, respectively; p < 0.0001), and well-being (63% and 93%, respectively; p < 0.0001). Multiple interventions provided: opioids, reviews for polypharmacy, constipation management, and interdisciplinary counseling. Median time from outpatient consultation to follow-up was 29 days(range, 1-119 days) at the PH and 21 days (range, 1-275 days) at the CCC (p = 0.0006). Median overall survival time from outpatient consultation was 473 days (95% confidence interval [CI], 205-699 days) at PH and 245 days (95% CI, 152-491 days) at CCC (p = 0.3408).
Advanced cancer patients at both institutions frequently had multiple distressing physical and emotional symptoms, although the frequency was higher at CCC. The median overall survival duration was higher at the PH. More research is needed.
患有晚期癌症的患者经历严重的身体、心理社会和精神困扰，需要姑息治疗（PC）。关于在公立医院（PH）接受 PC 服务评估的患者的特征和结局，文献有限。目的、设计、背景/对象和测量：比较在 PH 和综合癌症中心（CCC）接受 PC 的晚期癌症患者的结局。我们回顾了 359 例连续接受 PC 的晚期癌症患者（PH，180 例；CCC，179 例）。评估了就诊时和首次随访时的症状和结局。使用汇总统计数据描述患者特征和结局。
PH 和 CCC 患者的种族差异显著：PH 为 23%白人、39%黑人、36%西班牙裔，而 CCC 为 66%白人、17%黑人、11%西班牙裔（p<0.0001）。PH 有 96 例（53%）和 CCC 有 178 例（99%）患者有健康保险（p<0.0001）。PH 和 CCC 的就诊时症状分别为疼痛（85%和 91%，分别；p=0.0639）、疲劳（81%和 94%，分别；p=0.0003）、抑郁（51%和 69%，分别；p=0.0013）、焦虑（47%和 75%，分别；p<0.0001）和幸福感（63%和 93%，分别；p<0.0001）。提供的多项干预措施包括：阿片类药物、药物使用审查、便秘管理和多学科咨询。PH 的门诊咨询到随访的中位时间为 29 天（范围，1-119 天），而 CCC 的中位时间为 21 天（范围，1-275 天）（p=0.0006）。PH 的门诊咨询后总体生存时间中位数为 473 天（95%置信区间[CI]，205-699 天），而 CCC 为 245 天（95% CI，152-491 天）（p=0.3408）。
两所机构的晚期癌症患者经常出现多种令人痛苦的身体和情绪症状，尽管 CCC 的频率更高。PH 的中位总生存时间更长。需要进一步研究。
