McNaughton Caitlyn H, Horst Michael, Gehron Emily, Sivendran Shanthi, Nguyen Julie, Holliday Rachel, Newport Kristina
Penn Medicine at Lancaster General Health, Ann B Barshinger Cancer Institute, Lancaster, PA, USA.
Pennsylvania State University College of Medicine, Section of Palliative Care, Hershey, PA, USA.
J Palliat Care. 2020 Jan;35(1):34-39. doi: 10.1177/0825859719851492. Epub 2019 May 27.
Palliative care in oncology provides multiple benefits, however access to specialty palliative clinicians is limited in community cancer centers. Individual support services are more often available, but little is known on the utilization and impact of these services.
To describe the utilization of outpatient support services in the advanced cancer population and the association with ED and hospital use in a community setting.
A retrospective chart review of 314 patients with advanced cancer of lung, gastrointestinal, genitourinary, and gynecologic origin was conducted. Data collected included demographics, descriptive data, type and number of support services (symptom management, nurse navigator, social worker, nutrition, financial counselor, chaplain, and oncology clinical counselor) within 90 days of diagnosis and descriptions of ED visits/hospitalizations within 12 months of diagnosis. Support services were available to patients by referral.
29.6% of patients were deceased within 6 months and were considered to have severe disease. Patients with severe disease had a significantly greater mean number of support services than patients with non-severe disease (8.9 vs 6.0, p=0.001) and had a greater mean number of visits per year to the ED (6.4 vs 1.8, <0.001). A greater proportion of patients with severe disease had palliative consultations (48.9% vs 21.7%, <0.001), but 65.5% of palliative consultations occurred after an ED or hospital visit.
Our data demonstrated that advanced cancer patients with severe disease had increased healthcare utilization in all areas measured. Despite high utilization, outpatient support services used in a reactive manner were not effective in reducing ED or hospital visits.
肿瘤姑息治疗有诸多益处，但社区癌症中心获得专科姑息治疗临床医生的机会有限。个体支持服务更常可用，但对这些服务的利用情况和影响了解甚少。
描述晚期癌症患者门诊支持服务的利用情况以及在社区环境中与急诊和住院使用的关联。
对314例肺癌、胃肠道癌、泌尿生殖系统癌和妇科癌的晚期癌症患者进行回顾性病历审查。收集的数据包括人口统计学、描述性数据、诊断后90天内支持服务的类型和数量（症状管理、护士导航员、社会工作者、营养、财务顾问、牧师和肿瘤临床顾问）以及诊断后12个月内急诊就诊/住院情况的描述。支持服务通过转诊提供给患者。
29.6%的患者在6个月内死亡，被认为患有严重疾病。患有严重疾病的患者平均获得的支持服务数量显著多于非严重疾病患者（8.9对6.0，p = 0.001），且每年急诊就诊的平均次数更多（6.4对1.8，<0.001）。患有严重疾病的患者中接受姑息治疗咨询服务的比例更高（48.9%对21.7%，<0.001），但65.5%的姑息治疗咨询是在急诊或住院就诊后进行的。
我们的数据表明，患有严重疾病的晚期癌症患者在所有测量领域的医疗保健利用率都有所提高。尽管利用率很高，但以反应性方式使用的门诊支持服务在减少急诊或住院就诊方面并不有效。
