Hemminger Lauryn E, Pittman Christine A, Korones David N, Serventi Jennifer N, Ladwig Susan, Holloway Robert G, Mohile Nimish A
University of Rochester School of Medicine (L. E. H); University of Rochester Department of Neurosurgery (C. A. P.); University of Rochester Department of Neurology (J. N. S, R. G. H, N. A.); University of Rochester Department of Pediatrics (D. N. K); University of Rochester Division of Palliative Care (S. L).
Neurooncol Pract. 2017 Sep;4(3):182-188. doi: 10.1093/nop/npw022. Epub 2016 Sep 27.
American Society for Clinical Oncology (ASCO) quality measures for terminal cancers recommend early advance care planning and hospice at the end of life. We sought to evaluate adherence to 5 palliative care quality measures and explore associations with patient outcomes in glioblastoma.
This is a retrospective analysis of 117 deceased glioblastoma patients over 5 years. Records were reviewed to describe adherence to palliative care quality measures and patient outcomes. Data regarding emotional assessments, advance directives, palliative care consultation, chemotherapy administration, hospice, location of death, and overall survival were collected.
Median overall survival was 12.9 months. By the second oncology visit, 22.2% (26/117) had an emotional assessment completed. Advance directives were documented for 52.1% (61/117) by the third neuro-oncology visit (30/61 health care proxy), yet 26.5% (31/117) did not have any advance directive before the last month of life. With regard to other ASCO quality measures, 36.8% (43/117) had a palliative care consult; 94.0% (110/117) did not receive chemotherapy in the last 14 days of life; 59.8% (70/117) enrolled in hospice >7 days before death; and 56.4% (66/117) died in a home setting. Patients who enrolled in hospice >7 days before death were 3.56 times more likely to die in a home setting than patients enrolled <7 days before death or with no hospice enrollment ( = .002, [OR 3.56; 95% CI, 1.57-8.04]).
Late advance directive documentation, minimal early palliative care involvement, and the association of early hospice enrollment with death in a home setting underscore the need to improve care and better define palliative care quality measures in glioblastoma.
美国临床肿瘤学会（ASCO）针对晚期癌症的质量指标建议在生命末期进行早期的预立医疗计划和临终关怀。我们旨在评估胶质母细胞瘤患者对5项姑息治疗质量指标的依从性，并探讨其与患者预后的相关性。
这是一项对117例在5年内死亡的胶质母细胞瘤患者的回顾性分析。查阅记录以描述对姑息治疗质量指标的依从情况和患者预后。收集有关情绪评估、预立医疗指示、姑息治疗会诊、化疗给药、临终关怀、死亡地点和总生存期的数据。
总生存期的中位数为12.9个月。在第二次肿瘤学就诊时，22.2%（26/117）的患者完成了情绪评估。在第三次神经肿瘤学就诊时，52.1%（61/117）的患者有预立医疗指示记录（61例中有30例指定了医疗代理人），然而26.5%（31/117）的患者在生命的最后一个月之前没有任何预立医疗指示。关于其他ASCO质量指标，36.8%（43/117）的患者接受了姑息治疗会诊；94.0%（110/117）的患者在生命的最后14天未接受化疗；59.8%（70/117）的患者在死亡前7天以上入住临终关怀机构；56.4%（66/117）的患者在家中死亡。在死亡前7天以上入住临终关怀机构的患者在家中死亡的可能性是在死亡前7天内入住或未入住临终关怀机构患者的3.56倍（P = .002，[OR 3.56；95% CI，1.57 - 8.04]）。
预立医疗指示记录滞后、早期姑息治疗参与度低以及早期入住临终关怀机构与在家中死亡之间的关联凸显了改善胶质母细胞瘤护理并更好地定义姑息治疗质量指标的必要性。
