多学科门诊专科姑息治疗对晚期癌症成人生存和生活质量的影响：随机对照试验的荟萃分析。
Impact of Interdisciplinary Outpatient Specialty Palliative Care on Survival and Quality of Life in Adults With Advanced Cancer: A Meta-Analysis of Randomized Controlled Trials.
机构信息
Departments of Psychology, Psychiatry, and Medicine, Tulane University, New Orleans, LA.
Department of Epidemiology, Tulane University, New Orleans, LA.
出版信息
Ann Behav Med. 2019 Jun 4;53(7):674-685. doi: 10.1093/abm/kay077.
BACKGROUND
In advanced cancer, patients want to know how their care options may affect survival and quality of life, but the impact of outpatient specialty palliative care on these outcomes in cancer is uncertain.
PURPOSE
To estimate the impact of outpatient specialty palliative care programs on survival and quality of life in adults with advanced cancer.
METHODS
Following PRISMA guidelines, we conducted a systematic review and meta-analysis of randomized controlled trials comparing outpatient specialty palliative care with usual care in adults with advanced cancer. Primary outcomes were 1 year survival and quality of life. Analyses were stratified to compare preliminary studies against higher-quality studies. Secondary outcomes were survival at other endpoints and physical and psychological quality-of-life measures.
RESULTS
From 2,307 records, we identified nine studies for review, including five high-quality studies. In the three high-quality studies with long-term survival data (n = 646), patients randomized to outpatient specialty palliative care had a 14% absolute increase in 1 year survival relative to controls (56% vs. 42%, p < .001). The survival advantage was also observed at 6, 9, 15, and 18 months, and median survival was 4.56 months longer (14.55 vs. 9.99 months). In the five high-quality studies with quality-of-life data (n = 1,398), outpatient specialty palliative care improved quality-of-life relative to controls (g = .18, p < .001), including for physical and psychological measures.
CONCLUSIONS
Patients with advanced cancer randomized to receive outpatient specialty palliative care lived longer and had better quality of life. Findings have implications for improving care in advanced cancer.
背景
在晚期癌症患者中，他们希望了解治疗方案对生存和生活质量的影响，但门诊专科姑息治疗对癌症患者这些结局的影响尚不确定。
目的
评估门诊专科姑息治疗方案对晚期癌症成人患者的生存和生活质量的影响。
方法
我们遵循 PRISMA 指南，对比较门诊专科姑息治疗与晚期癌症成人常规护理的随机对照试验进行了系统评价和荟萃分析。主要结局为 1 年生存率和生活质量。分析分层比较了初步研究和高质量研究。次要结局为其他终点的生存率和身体及心理生活质量指标。
结果
从 2307 条记录中，我们确定了 9 项研究进行综述，其中包括 5 项高质量研究。在 3 项具有长期生存数据的高质量研究（n = 646）中，与对照组相比，随机分配至门诊专科姑息治疗的患者 1 年生存率绝对增加 14%（56% vs. 42%，p <.001）。在 6、9、15 和 18 个月时也观察到了生存优势，中位生存期延长了 4.56 个月（14.55 个月 vs. 9.99 个月）。在 5 项具有生活质量数据的高质量研究（n = 1398）中，与对照组相比，门诊专科姑息治疗改善了生活质量（g =.18，p <.001），包括身体和心理指标。
结论
随机分配接受门诊专科姑息治疗的晚期癌症患者活得更长，生活质量更好。研究结果对改善晚期癌症患者的护理具有重要意义。
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