1 Duke University Medical Center, Durham, NC.
2 Veterans Health Administration Support Service Center, Washington, DC.
J Oncol Pract. 2019 Jun;15(6):e568-e575. doi: 10.1200/JOP.18.00559. Epub 2019 May 2.
It is imperative to provide quality end-of-life (EOL) care for patients with cancer. Although rates of hospice use within the Veterans Health Administration have improved, antineoplastic administration and intensive care unit (ICU) admission at the EOL, indicators of aggressive care, have not clearly declined over recent years.
We identified 32,665 veterans diagnosed with stage IV lung, colorectal, or pancreatic cancer who died between 2009 and 2016 using a novel EOL Dashboard Tool created from Veterans Administration Cancer Registry data. This EOL tool reports the incidence of antineoplastic drug use in the last 14 days of life, ICU admission in the last 30 days of life, and hospice admission or consult. Change from 2009 to 2016 was assessed using a repeated measures one-way analysis of variance with post hoc test for linear trend of time for individual cancers and two-way analysis of variance for all cancers combined.
Antineoplastic use in the last 14 days of life declined from 6.8% in 2009 to 4.4% in 2016 ( = .03). ICU admission in the last 30 days did not change significantly, from 13.3% in 2009 to 14.7% in 2016. The exception was patients with stage IV lung cancer, in whom ICU admissions increased from 12.9% to 16.2% ( = .01). Patients using hospice services increased from 32.4% to 52.6% ( < .01).
Although antineoplastic administration at the EOL is declining for veterans with stage IV cancer, ICU admissions are unchanged and becoming more common in stage IV lung cancer despite increasing hospice use.
为癌症患者提供高质量的临终关怀至关重要。尽管退伍军人事务部的临终关怀使用率有所提高，但近年来，临终关怀时的抗肿瘤药物治疗和重症监护病房（ICU）入院率并没有明显下降，这些都是积极治疗的指标。
我们使用退伍军人事务部癌症登记处的数据创建了一个新的临终关怀仪表板工具，从该工具中确定了 2009 年至 2016 年间诊断为 IV 期肺癌、结直肠癌或胰腺癌的 32665 名退伍军人，这些退伍军人死亡。该临终关怀工具报告了生命最后 14 天内使用抗肿瘤药物、生命最后 30 天内入住 ICU 以及临终关怀入院或咨询的发生率。使用重复测量的单向方差分析评估 2009 年至 2016 年的变化，对于个别癌症采用线性趋势的事后检验，对于所有癌症采用双向方差分析。
生命最后 14 天内使用抗肿瘤药物的比例从 2009 年的 6.8%下降到 2016 年的 4.4%（ =.03）。生命最后 30 天内入住 ICU 的比例没有明显变化，从 2009 年的 13.3%到 2016 年的 14.7%。例外的是 IV 期肺癌患者，他们入住 ICU 的比例从 12.9%上升到 16.2%（ =.01）。使用临终关怀服务的患者比例从 32.4%上升到 52.6%（ <.01）。
尽管 IV 期癌症退伍军人的临终关怀时抗肿瘤药物治疗有所减少，但 ICU 入院率保持不变，并且在 IV 期肺癌中变得更为常见，尽管临终关怀的使用有所增加。
