Department of Surgery, Queen's University, Kingston, ON, Canada.
Division of General Surgery and Surgical Oncology, Kingston Health Sciences Centre, Kingston, ON, Canada.
Ann Surg Oncol. 2019 Aug;26(8):2336-2345. doi: 10.1245/s10434-019-07320-z. Epub 2019 Apr 9.
The symptom profile in cancer patients and the association between palliative care (PC) and symptoms has not been studied in the general population. We addressed these gaps in gastrointestinal (GI) cancer patients in the final year of life.
Patients dying of esophageal, gastric, colon, and anorectal cancers during 2003-2015 were identified. Symptom scores were recorded in the year before death using the Edmonton Symptom Assessment System (ESAS), which includes scores from 0 to 10 in nine domains. Symptom severity was categorized as none-mild (≤ 3) or moderate-severe (≥ 4-10). Adjusted associations between outpatient PC and moderate-severe ESAS scores were determined, and the effect of PC initiation on ESAS scores was estimated.
The cohort included 11,242 patients who died (esophageal [17%], gastric [20%], colon [38%], and anorectal [26%] cancers). Fifty percent experienced moderate-severe scores in tiredness, lack of well-being, and lack of appetite earlier (weeks 18 to 12 before death), whereas 50% experienced moderate-severe scores in drowsiness, pain, and shortness of breath later (weeks 5 to 2 before death) in the disease course. Outpatient PC was associated with an increased likelihood of moderate-severe scores in all domains, with the highest score in pain (odds ratio [OR] 1.86, 95% confidence interval [CI] 1.68-2.05). In PC-naïve patients with moderate-severe scores, initiation of outpatient PC was associated with a 1- to 3-point decrease in subsequent scores, with the greatest reductions in pain (OR - 1.91, 95% CI - 2.11 to - 1.70) and nausea (OR - 3.01, 95% CI - 3.31 to - 2.71).
GI cancer patients experience high symptom burden in the final year of life. Outpatient PC initiation is associated with a decrease in symptoms.
在普通人群中，尚未研究癌症患者的症状特征以及姑息治疗（PC）与症状之间的关联。我们针对终末期胃肠道（GI）癌症患者填补了这一空白。
确定了 2003 年至 2015 年间死于食管、胃、结肠和直肠肛门癌的患者。在死亡前一年使用埃德蒙顿症状评估系统（ESAS）记录症状评分，该系统包括 0 至 10 分的 9 个领域的评分。症状严重程度分为无-轻度（≤3）或中度-重度（≥4-10）。确定了门诊 PC 与中度-重度 ESAS 评分之间的调整关联，并估计了 PC 开始对 ESAS 评分的影响。
该队列包括 11242 名死亡患者（食管癌[17%]、胃癌[20%]、结肠癌[38%]和直肠癌[26%]）。50%的患者在疾病过程中更早（死亡前 18 至 12 周）出现疲劳、不适和食欲不振的中度-重度评分，而 50%的患者在较晚（死亡前 5 至 2 周）出现嗜睡、疼痛和呼吸急促的中度-重度评分。门诊 PC 与所有领域的中度-重度评分的可能性增加相关，疼痛的评分最高（比值比[OR] 1.86，95%置信区间[CI] 1.68-2.05）。在有中度-重度评分且无门诊 PC 经验的患者中，门诊 PC 的启动与随后评分的 1 至 3 分下降相关，在疼痛（OR-1.91，95%CI-2.11 至-1.70）和恶心（OR-3.01，95%CI-3.31 至-2.71）方面的降幅最大。
GI 癌症患者在生命的最后一年中经历了高症状负担。门诊 PC 的启动与症状的减轻有关。
