Liu Xibei, Shen Jay J, Kim Pearl, Kim Sun Jung, Ukken Johnson, Choi Younseon, Hwang In Choel, Lee Jae-Hoon, Chun Sung-Youn, Hwang Jinwook, Choi Haneul, Yeom Hyeyoung, Lee Yong-Jae, Yoo Ji Won
Department of Medicine, University of Arizona College of Medicine, Tuscon, AZ, USA.
Department of Healthcare Administration and Policy, University of Nevada, Las Vegas, Las Vegas, NV, USA.
J Palliat Care. 2019 Oct;34(4):232-240. doi: 10.1177/0825859719827313. Epub 2019 Feb 15.
Pancreas cancer continues to carry a poor prognosis. Hospitalized patients with advanced chronic pancreatic illnesses increasingly receive palliative care due to its perceived clinical benefits. Meanwhile, a growing proportion of elderly patients are reportedly receiving life-sustaining procedures. Temporal trends in the utilization of life-sustaining procedures and palliative care consultation among dying patients with advanced chronic pancreatic illnesses in US hospitals were examined.
A serial, cross-sectional analysis was carried out using the National Inpatient Sample Database. Decedents 18 years and older with a principal diagnosis of pancreas cancer or other advanced chronic pancreatic illnesses from 2005 through 2014. The compound annual growth rates (CAGRs) and Cochrane-Armitage correction of χ statistic were used. The receipt of life-sustaining systemic procedures, intra-abdominal local procedures and surgeries, and palliative care consultation were examined. Multilevel multivariate logistic regressions were performed to examine the association of various procedures with the utilization of palliative care consultation.
Among 77 394 183 hospitalizations, 29 515 patients were examined. The CAGRs of systemic procedures, intra-abdominal procedures, surgeries, and palliative care were -4.19% ( = .008), 2.17%, -1.40%, and 14.03% ( < .001), respectively. The receipt of systemic procedures (odds ratio [OR] = 2.40, 95% confidence interval [CI], 2.08-2.74), local intra-abdominal procedures (OR = 1.46, 95% CI, 1.27-1.70), and surgeries (OR = 2.51, 95% CI, 2.07-3.05) was associated with palliative care consultation (s < .001).
Among adults with pancreatic cancer or other advanced chronic pancreatic illnesses in the US hospitals from 2005 to 2014, the utilization of life-sustaining systemic procedures decreased while the prevalence of palliative care consultation increased.
胰腺癌的预后仍然很差。由于姑息治疗具有明显的临床益处，患有晚期慢性胰腺疾病的住院患者越来越多地接受姑息治疗。与此同时，据报道，越来越多的老年患者正在接受维持生命的治疗。本研究调查了美国医院中晚期慢性胰腺疾病临终患者维持生命治疗和姑息治疗咨询的使用时间趋势。
使用国家住院样本数据库进行了一项系列横断面分析。研究对象为2005年至2014年期间主要诊断为胰腺癌或其他晚期慢性胰腺疾病的18岁及以上死者。采用复合年增长率（CAGR）和χ统计量的 Cochr ane-Armitage校正。研究了维持生命的全身治疗、腹腔内局部治疗和手术以及姑息治疗咨询的接受情况。进行多水平多变量逻辑回归分析，以研究各种治疗与姑息治疗咨询使用之间的关联。
在77394183例住院病例中，对29515例患者进行了检查。全身治疗、腹腔内治疗、手术和姑息治疗的CAGR分别为-4.19%（P = 0.008）、2.17%、-1.40%和14.03%（P < 0.001）。接受全身治疗（比值比[OR]=2.40，95%置信区间[CI]，2.08 - 2.74）、腹腔内局部治疗（OR = 1.46，95%CI，1.27 - 1.70）和手术（OR = 2.51，95%CI，2.07 - 3.05）与姑息治疗咨询相关（P < 0.001）。
在2005年至2014年美国医院中患有胰腺癌或其他晚期慢性胰腺疾病的成年人中，维持生命的全身治疗的使用减少，而姑息治疗咨询的普及率增加。
