Division of Pulmonary and Critical Care Medicine, Department of Medicine, Oregon Health and Science University, Portland.
Health Services Research and Development, Veterans Affairs Portland Health Care System, Portland, Oregon.
JAMA Oncol. 2019 Dec 1;5(12):1702-1709. doi: 10.1001/jamaoncol.2019.3105.
Palliative care is a patient-centered approach associated with improvements in quality of life; however, results regarding its association with a survival benefit have been mixed, which may be a factor in its underuse.
To assess whether early palliative care is associated with a survival benefit among patients with advanced lung cancer.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective population-based cohort study was conducted among patients with lung cancer who were diagnosed with cancer between January 1, 2007, and December 31, 2013, with follow-up until January 23, 2017. Participants comprised 23 154 patients with advanced lung cancer (stage IIIB and stage IV) who received care in the Veterans Affairs health care system. Data were analyzed from February 15, 2019, to April 28, 2019.
Palliative care defined as a specialist-delivered palliative care encounter received after lung cancer diagnosis.
The primary outcome was survival. The association between palliative care and place of death was also examined. Propensity score and time-varying covariate methods were used to calculate Cox proportional hazards and to perform regression modeling.
Of the 23 154 patients enrolled in the study, 57% received palliative care. The mean (SD) age of participants was 68 (9.5) years, and 98% of participants were men. An examination of the timing of palliative care receipt relative to cancer diagnosis found that palliative care received 0 to 30 days after diagnosis was associated with decreases in survival (adjusted hazard ratio [aHR], 2.13; 95% CI, 1.97-2.30), palliative care received 31 to 365 days after diagnosis was associated with increases in survival (aHR, 0.47; 95% CI, 0.45-0.49), and palliative care received more than 365 days after diagnosis was associated with no difference in survival (aHR, 1.00; 95% CI, 0.94-1.07) compared with nonreceipt of palliative care. Receipt of palliative care was also associated with a reduced risk of death in an acute care setting (adjusted odds ratio, 0.57; 95% CI, 0.52-0.64) compared with nonreceipt of palliative care.
The results suggest that palliative care was associated with a survival benefit among patients with advanced lung cancer. Palliative care should be considered a complementary approach to disease-modifying therapy in patients with advanced lung cancer.
姑息治疗是一种以患者为中心的方法，与生活质量的改善有关；然而，关于其与生存获益相关的结果存在差异，这可能是其未被广泛应用的一个因素。
评估早期姑息治疗是否与晚期肺癌患者的生存获益相关。
设计、设置和参与者：这是一项回顾性基于人群的队列研究，纳入了 2007 年 1 月 1 日至 2013 年 12 月 31 日期间被诊断患有肺癌的患者，随访至 2017 年 1 月 23 日。参与者包括 23154 名患有晚期肺癌（IIIb 期和 IV 期）的患者，他们在退伍军人事务部医疗保健系统中接受了治疗。数据分析于 2019 年 2 月 15 日至 2019 年 4 月 28 日进行。
姑息治疗的定义为肺癌诊断后接受的由专家提供的姑息治疗。
主要结局是生存。还检查了姑息治疗与死亡地点之间的关系。采用倾向评分和时变协变量方法计算 Cox 比例风险和进行回归建模。
在纳入研究的 23154 名患者中，57%接受了姑息治疗。参与者的平均（SD）年龄为 68（9.5）岁，98%的参与者为男性。对姑息治疗接受时间与癌症诊断的关系进行了检查，发现诊断后 0 至 30 天内接受姑息治疗与生存时间缩短相关（调整后的危险比[aHR]，2.13；95%CI，1.97-2.30），诊断后 31 至 365 天内接受姑息治疗与生存时间延长相关（aHR，0.47；95%CI，0.45-0.49），诊断后超过 365 天接受姑息治疗与未接受姑息治疗相比，生存时间无差异（aHR，1.00；95%CI，0.94-1.07）。与未接受姑息治疗相比，接受姑息治疗还与在急症护理环境中死亡风险降低相关（调整后的优势比，0.57；95%CI，0.52-0.64）。
结果表明，姑息治疗与晚期肺癌患者的生存获益相关。姑息治疗应该被视为晚期肺癌患者疾病修饰治疗的补充方法。
