无法切除的胰腺癌患者的临终前姑息治疗咨询和积极治疗。
Palliative care consultation and aggressive care at end of life in unresectable pancreatic cancer.
机构信息
Division of Palliative Medicine, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS.
Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS.
出版信息
Curr Oncol. 2019 Feb;26(1):28-36. doi: 10.3747/co.26.4389. Epub 2019 Feb 1.
BACKGROUND
Palliative care (pc) consultation has been associated with less aggressive care at end of life in a number of malignancies, but the effect of the consultation timing has not yet been fully characterized. For patients with unresectable pancreatic cancer (upcc), aggressive and resource-intensive treatment at the end of life can be costly, but not necessarily of better quality. In the present study, we investigated the association, if any, between the timing of specialist pc consultation and indicators of aggressive care at end of life in patients with upcc.
METHODS
This retrospective cohort study examined the potential effect of the timing of specialist pc consultation on key indicators of aggressive care at end of life in all patients diagnosed with upcc in Nova Scotia between 1 January 2010 and 31 December 2015. Statistical analysis included univariable and multivariable logistic regression.
RESULTS
In the 365 patients identified for inclusion in the study, specialist pc consultation was found to be associated with decreased odds of experiencing an indicator of aggressive care at end of life; however, the timing of the consultation was not significant. Residency in an urban area was associated with decreased odds of experiencing an indicator of aggressive care at end of life. We observed no association between experiencing an indicator of aggressive care at end of life and consultation with medical oncology or radiation oncology.
CONCLUSIONS
Regardless of timing, specialist pc consultation was associated with decreased odds of experiencing an indicator of aggressive care at end of life. That finding provides further evidence to support the integral role of pc in managing patients with a life-limiting malignancy.
背景
在许多恶性肿瘤中，姑息治疗（pc）咨询与生命末期较少的侵袭性治疗相关，但咨询时机的影响尚未得到充分描述。对于不可切除的胰腺癌（upcc）患者，生命末期的侵袭性和资源密集型治疗可能代价高昂，但不一定能提高生活质量。在本研究中，我们调查了专家 pc 咨询时机与 upcc 患者生命末期侵袭性治疗指标之间的任何关联。
方法
这项回顾性队列研究调查了专家 pc 咨询时机对 2010 年 1 月 1 日至 2015 年 12 月 31 日期间在新斯科舍省被诊断为 upcc 的所有患者生命末期侵袭性治疗指标的潜在影响。统计分析包括单变量和多变量逻辑回归。
结果
在纳入研究的 365 名患者中，专家 pc 咨询与生命末期侵袭性治疗指标的发生几率降低相关；然而，咨询时机并不显著。居住在城市地区与生命末期侵袭性治疗指标的发生几率降低相关。我们未观察到生命末期侵袭性治疗指标的发生与肿瘤内科或放射肿瘤学咨询之间存在关联。
结论
无论咨询时机如何，专家 pc 咨询与生命末期侵袭性治疗指标的发生几率降低相关。这一发现为姑息治疗在管理生命有限的恶性肿瘤患者中的重要作用提供了进一步的证据。
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