Pneumologie, Hopital d'Instruction des Armees Percy, Clamart, France
Service de Pneumologie, Centre Hospitalier Intercommunal de Creteil, Creteil, France.
BMJ Support Palliat Care. 2019 Dec;9(4):413-424. doi: 10.1136/bmjspcare-2019-001770. Epub 2019 Aug 31.
Despite recent advances in thoracic oncology, most patients with metastatic lung cancer die within months of diagnosis. Aggressiveness of their end-of-life (EOL) care has been the subject of numerous studies. This study was undertaken to evaluate the literature on aggressive inpatient EOL care for lung cancer and analyse the evolution of its aggressiveness over time.
A systematic international literature search restricted to English-language publications used terms associated with aggressiveness of care, EOL and their synonyms. Two independent researchers screened for eligibility and extracted all data and another a random 10% sample of the abstracts. Electronic Medline and Embase databases were searched (2000-20 September 2018). EOL-care aggressiveness was defined as follows: 1) chemotherapy administered during the last 14 days of life (DOL) or new chemotherapy regimen during the last 30 DOL; 2) >2 emergency department visits; 3) >1 hospitalisation during the last 30 DOL; 4) ICU admission during the last 30 DOL and 5) palliative care started <3 days before death.
Among the 150 articles identified, 42 were retained for review: 1 clinical trial, 3 observational cohorts, 21 retrospective analyses and 17 administrative data-based studies. The percentage of patients subjected to aggressive therapy seems to have increased over time. Early management by palliative care teams seems to limit aggressive care.
Our analysis indicated very frequent aggressive EOL care for patients with lung cancer, regardless of the definition used. The extent of that aggressiveness and its impact on healthcare costs warrant further studies.
尽管胸部肿瘤学近年来取得了进展，但大多数转移性肺癌患者在确诊后数月内死亡。他们临终关怀的积极性一直是许多研究的主题。本研究旨在评估有关肺癌积极的住院临终关怀的文献，并分析其随时间推移的积极性演变。
采用与关怀积极性、临终关怀及其同义词相关的术语，对英语文献进行了系统的国际文献检索。两名独立研究人员筛选合格文献并提取所有数据，另一名研究人员随机抽取 10%的摘要样本。检索了电子 Medline 和 Embase 数据库（2000 年至 2018 年 9 月 20 日）。临终关怀积极性定义如下：1）生命最后 14 天内给予化疗或生命最后 30 天内给予新的化疗方案；2）急诊就诊>2 次；3）生命最后 30 天内住院>1 次；4）生命最后 30 天内入住 ICU；5）临终关怀开始<3 天前死亡。
在确定的 150 篇文章中，有 42 篇被保留用于审查：1 项临床试验、3 项观察性队列研究、21 项回顾性分析和 17 项基于行政数据的研究。接受积极治疗的患者比例似乎随着时间的推移而增加。姑息治疗团队的早期管理似乎限制了积极治疗。
我们的分析表明，无论使用何种定义，肺癌患者的临终关怀都非常积极。这种积极性的程度及其对医疗保健成本的影响值得进一步研究。
