National Cancer Registry Ireland and Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
National Cancer Registry Ireland and Cork Institute of Technology, Cork, Ireland.
BMC Palliat Care. 2018 Feb 26;17(1):37. doi: 10.1186/s12904-018-0285-5.
Analysing linked, routinely collected data may be useful to identify characteristics of patients with suspected lung cancer who could benefit from early assessment for palliative care. The aim of this study was to compare characteristics of newly diagnosed lung cancer patients dying within 30 days of diagnosis (short term survivors) with those surviving more than 30 days. To identify indicators for early palliative care assessment we distinguished between characteristics available at diagnosis (age, gender, smoking status, marital status, comorbid disease, admission type, tumour stage and histology) from those available post diagnosis. A second aim was to examine the association between receiving any tumour-directed treatment, place of death and survival time.
A retrospective observational population based study comparing lung cancer patients who died within 30 days of diagnosis (short term survivors) with those who survived longer using Chi-squared tests and logistic regression. Incident lung cancer (ICD-03:C34) patients diagnosed 2005-2012 inclusive who died before 01-01-2014 (n = 14,228) were identified from the National Cancer Registry of Ireland linked to death certificate data and acute hospital episode data.
One in five newly diagnosed lung cancer patients died within 30 days of diagnosis. After adjusting for stage and histology, death within 30 days was higher in patients who were aged 80 years or older (adjusted OR 2.46; 95%CI 2.05-3.96; p < 0.001), patients with emergency admissions at diagnosis (adjusted OR 2.96; 95%CI 2.61-3.37; p < 0.001) and patients with any comorbidities at diagnosis (adjusted OR 1.32 95%CI 1.15-1.52; p < 0.001). Overall, 75% of those who died within 30 days died in hospital compared to 43% of longer term survivors.
We have shown a high proportion of lung cancer patients who die within 30 days of diagnosis are older, have comorbidities and are admitted through the emergency department. These characteristics, available at diagnosis, may be useful prognostic factors to guide decisions on early assessment for palliative care for lung cancer patients. Patients who die shortly after diagnosis are more likely to die in hospital so reporting place of death by survival time may be useful to evaluate interventions to reduce deaths in acute hospitals.
分析关联的常规收集数据可能有助于确定疑似肺癌患者的特征，这些患者可能需要早期评估姑息治疗。本研究的目的是比较诊断后 30 天内死亡（短期幸存者）的新诊断肺癌患者与存活时间超过 30 天的患者的特征。为了确定早期姑息治疗评估的指标，我们将诊断时可用的特征（年龄、性别、吸烟状况、婚姻状况、合并症、入院类型、肿瘤分期和组织学）与诊断后可用的特征区分开来。第二个目的是检查接受任何肿瘤靶向治疗、死亡地点和生存时间之间的关联。
一项回顾性观察性基于人群的研究，比较了诊断后 30 天内死亡（短期幸存者）的肺癌患者与存活时间较长的患者，使用卡方检验和逻辑回归。从爱尔兰国家癌症登记处确定了 2005 年至 2012 年期间包括的所有诊断为肺癌（ICD-03：C34）的患者，并将其与死亡证明数据和急性医院发病数据相关联，这些患者在 2014 年 1 月 1 日之前死亡（n=14228）。
五分之一的新诊断肺癌患者在诊断后 30 天内死亡。在调整了分期和组织学后，80 岁或以上的患者在 30 天内死亡的风险更高（调整后的 OR 2.46；95%CI 2.05-3.96；p<0.001），在诊断时接受急诊入院的患者（调整后的 OR 2.96；95%CI 2.61-3.37；p<0.001）和在诊断时存在任何合并症的患者（调整后的 OR 1.32，95%CI 1.15-1.52；p<0.001）。总体而言，30 天内死亡的患者中有 75%在医院死亡，而长期幸存者中有 43%在医院死亡。
我们发现，在诊断后 30 天内死亡的肺癌患者中有很大一部分年龄较大、有合并症并且通过急诊入院。这些在诊断时即可获得的特征可能是指导对肺癌患者进行姑息治疗早期评估的有用预后因素。诊断后不久死亡的患者更有可能在医院死亡，因此按生存时间报告死亡地点可能有助于评估减少急性医院死亡的干预措施。
