Oncology and Palliative Care Units, Civil Hospital Carpi, USL, Carpi, Italy.
Statistic Unit, Department of Medical and Surgical Sciences, UNIMORE, Modena, Italy.
BMJ Support Palliat Care. 2020 Dec;10(4):e32. doi: 10.1136/bmjspcare-2019-001794. Epub 2019 Jun 14.
The positive impact of early palliative care interventions in advanced cancer patients has so far been largely evaluated in randomised controlled trials. This study aimed at providing information on the value of early palliative/supportive care, integrated with standard oncologic care, in a real-life setting.
This was a retrospective observational study of 292 advanced cancer patients consecutively admitted at Carpi Hospital in Modena, Italy, between 2014 and 2017. For the purpose of this analysis, patients were classified into two groups (early and delayed palliative/supportive care patients), and analysed for different clinical indicators. Early and delayed palliative/supportive care were classified according to the time elapsed from advanced cancer diagnosis until palliative/supportive care start.
A total of 200 patients (68%), with at least three visits, were included in the analyses. The frequency of chemotherapy use in the last 60 days of life was 3.4% and 24.6% in the early and delayed groups, respectively (adjusted OR=0.1; 95% CI 0.0 to 0.4; p=0.002). The estimated survival probability at 1 year was 74.5% (95% CI 65.0% to 85.4%) and 45.5% (95% CI 37.6% to 55.0%), in the early and delayed groups, respectively. Performance status, pain and all the Edmonton Symptom Assessment Scale items, assessed at baseline and at 1 to 12 weeks after the intervention, showed significant improvement over time. However, no between-group differences were found with regard to symptom outcomes.
An earlier palliative/supportive care intervention was associated with reduced aggressiveness of therapy, in patients receiving community oncology care. Symptom burden was improved by early palliative/supportive care, independently of the timing of patient referral.
早期姑息治疗干预对晚期癌症患者的积极影响在很大程度上已在随机对照试验中得到评估。本研究旨在提供有关在实际环境中，将早期姑息/支持性治疗与标准肿瘤学治疗相结合的价值的信息。
这是一项回顾性观察研究，纳入了 2014 年至 2017 年期间在意大利摩德纳 Carpi 医院连续收治的 292 例晚期癌症患者。为了进行本分析，患者被分为两组（早期和延迟姑息/支持性治疗患者），并分析了不同的临床指标。早期和延迟姑息/支持性治疗根据从晚期癌症诊断到开始姑息/支持性治疗的时间进行分类。
共有 200 例（68%）至少接受了 3 次就诊的患者纳入分析。在生命的最后 60 天内使用化疗的频率分别为早期组和延迟组的 3.4%和 24.6%（调整后的 OR=0.1；95%CI 0.0 至 0.4；p=0.002）。在 1 年时的估计生存率分别为早期组的 74.5%（95%CI 65.0%至 85.4%）和延迟组的 45.5%（95%CI 37.6%至 55.0%）。在基线和干预后 1 至 12 周评估时，功能状态、疼痛和所有 Edmonton 症状评估量表项目均显示随时间的推移有显著改善。然而，在症状结局方面，两组之间没有差异。
在接受社区肿瘤学治疗的患者中，早期姑息/支持性治疗干预与治疗的侵袭性降低相关。早期姑息/支持性治疗可改善症状负担，而与患者转介时间无关。
