Paredes Anghela Z, Hyer J Madison, Tsilimigras Diamantis I, Mehta Rittal, Sahara Kota, White Susan, Dillhoff Mary E, Ejaz Aslam, Cloyd Jordan M, Pawlik Timothy M
Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio.
Division of Health Information Management and Systems, The Ohio State Wexner Medical Center, The Ohio State University, Columbus, Ohio.
J Surg Oncol. 2019 Sep;120(4):624-631. doi: 10.1002/jso.25623. Epub 2019 Jul 9.
Use of hospice services among patients with pancreatic cancer following pancreatic resection remains unknown.
Patients with pancreatic cancer who underwent resection were identified in the Medicare Standard Analytic Files. Outcomes included overall hospice use, early hospice enrollment (≥4 weeks before death), late hospice enrollment (initiation within 3 days of death), and Medicare expenditures.
Among the 4369 deceased individuals, three-fourths of patients (n = 3252, 74.4%) used hospice at the time of death. Patients who did not use hospice were more likely to be male, have a complication on index admission and receive life sustaining treatments on subsequent admissions (P < .05). Only one-third (32.2%) of patients initiated hospice services early. Medicare expenditure during the last month of life was $10 000 lower among patients who initialized hospice services at least 1 month before death versus within 3 days of death (late: $10 581 [$5454-$17 200], early: $221 [$46-$733]; P < .001) CONCLUSION: While three-fourths of patients utilized hospice services after pancreatic resection, only one-third of patients initiated hospice services at least one-month before death. Late hospice use was associated with higher Medicare expenditures during the last month of life. Further research is needed to understand barriers to early hospice utilization.
胰腺癌切除术后患者临终关怀服务的使用情况尚不清楚。
在医疗保险标准分析文件中识别出接受过切除术的胰腺癌患者。结局指标包括临终关怀服务的总体使用情况、临终关怀服务的早期登记（死亡前≥4周）、临终关怀服务的晚期登记（死亡前3天内开始）以及医疗保险支出。
在4369名死亡患者中，四分之三的患者（n = 3252，74.4%）在死亡时使用了临终关怀服务。未使用临终关怀服务的患者更可能为男性，在首次入院时出现并发症，并在随后的入院中接受维持生命的治疗（P < 0.05）。只有三分之一（32.2%）的患者早期开始接受临终关怀服务。与在死亡前3天内开始接受临终关怀服务（晚期：10581美元[5454 - 17200美元]）相比，在死亡前至少1个月开始接受临终关怀服务的患者在生命最后一个月的医疗保险支出低10000美元（早期：221美元[46 - 733美元]；P < 0.001）。结论：虽然四分之三的患者在胰腺癌切除术后使用了临终关怀服务，但只有三分之一的患者在死亡前至少1个月开始接受临终关怀服务。临终关怀服务的晚期使用与生命最后一个月较高的医疗保险支出相关。需要进一步研究以了解早期使用临终关怀服务的障碍。
