Osagiede Osayande, Colibaseanu Dorin T, Spaulding Aaron C, Frank Ryan D, Merchea Amit, Kelley Scott R, Uitti Ryan J, Ailawadhi Sikander
1 Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL, USA.
2 Department of Surgery, Mayo Clinic, Jacksonville, FL, USA.
J Palliat Care. 2018 Jul;33(3):149-158. doi: 10.1177/0825859718777320. Epub 2018 May 29.
Palliative care has been increasingly recognized as an important part of cancer care but remains underutilized in patients with solid cancers. There is a current gap in knowledge regarding why palliative care is underutilized nationwide.
To identify the factors associated with palliative care use among deceased patients with solid cancer tumors.
Using the 2016 National Cancer Data Base, we identified deceased patients (2004-2013) with breast, colon, lung, melanoma, and prostate cancer. Data were described as percentages. Associations between palliative care use and patient, facility, and geographic characteristics were evaluated through multivariate logistic regression.
A total of 1 840 111 patients were analyzed; 9.6% received palliative care. Palliative care use was higher in the following patient groups: survival >24 months (17% vs 2%), male (54% vs 46%), higher Charlson-Deyo comorbidity score (16% vs 8%), treatment at designated cancer programs (74% vs 71%), lung cancer (76% vs 28%), higher grade cancer (53% vs 24%), and stage IV cancer (59% vs 13%). Patients who lived in communities with a greater percentage of high school degrees had higher odds of receiving palliative care; Central and Pacific regions of the United States had lower odds of palliative care use than the East Coast. Patients with colon, melanoma, or prostate cancer had lower odds of palliative care than patients with breast cancer, whereas those with lung cancer had higher odds.
Palliative care use in solid cancer tumors is variable, with a preference for patients with lung cancer, younger age, known insurance status, and higher educational level.
姑息治疗已日益被视为癌症治疗的重要组成部分，但在实体癌患者中仍未得到充分利用。目前在全国范围内，对于姑息治疗未得到充分利用的原因存在知识空白。
确定实体癌肿瘤死亡患者中与姑息治疗使用相关的因素。
利用2016年国家癌症数据库，我们确定了2004 - 2013年期间死于乳腺癌、结肠癌、肺癌、黑色素瘤和前列腺癌的患者。数据以百分比形式呈现。通过多因素逻辑回归评估姑息治疗使用与患者、机构和地理特征之间的关联。
共分析了1840111例患者；9.6%接受了姑息治疗。以下患者群体的姑息治疗使用率较高：生存期>24个月（17%对2%）、男性（54%对46%）、Charlson - Deyo合并症评分较高（16%对8%）、在指定癌症项目接受治疗（74%对71%）、肺癌（76%对28%）、癌症分级较高（53%对24%）和IV期癌症（59%对13%）。居住在高中文凭比例较高社区的患者接受姑息治疗的几率更高；美国中部和太平洋地区接受姑息治疗的几率低于东海岸。结肠癌、黑色素瘤或前列腺癌患者接受姑息治疗的几率低于乳腺癌患者，而肺癌患者的几率较高。
实体癌肿瘤患者姑息治疗的使用情况各不相同，肺癌患者、年龄较轻、已知保险状况和教育水平较高的患者更倾向于接受姑息治疗。
