Aix-Marseille Univ., CEReSS - Health Service Research and Quality of Life Center, Marseille, France; Department of Medical Information, APHM, Marseille, France; Department of Epidemiology and Health Economics, APHM, Marseille, France.
Aix-Marseille Univ., CEReSS - Health Service Research and Quality of Life Center, Marseille, France.
J Affect Disord. 2020 Feb 15;263:326-335. doi: 10.1016/j.jad.2019.12.003. Epub 2019 Dec 5.
We still don't know if recurrent major depressive disorder (RMDD) may impact the quality of the end-of-life (EOL) cancer care in France. To tackle this knowledge gap, we explored EOL care in RMDD subjects who died from cancer compared to subjects without psychiatric disorder in a 4-year nationwide cohort study.
Nationwide cohort study.
National hospital database, France.
All patients aged ≥15 years who died from cancer in hospital: 4070 RMDD subjects and 222,477 controls, 2013-2016, France.
Palliative care in the last 31 days of life and high-intensity EOL care including chemotherapy in the last 14 days of life, artificial nutrition, tracheal intubation, mechanical ventilation, gastrostomy, cardiopulmonary resuscitation, dialysis, transfusion, surgery, endoscopy, imaging, intensive care unit and emergency department admission in the last 31 days of life. Multivariate generalized mixed models with log-normal distribution was used to compare RMDD subjects and controls.
Compared to the controls, the RMDD subjects died 3 years younger, had more comorbidities, more thoracic cancers, less metastases and longer time from cancer diagnosis to death. After matching and adjustment, subjects with RMDD were found to receive more palliative care and less high-intensity EOL care, had fewer iterative admissions to acute care unit, and died less often in the intensive care unit and emergency department.
RMDD subjects were more likely to receive palliative care associated with less high-intensity EOL care. Yet the interpretation may be discussed, resulting from either patients'/families' wishes or difficulties for providers in offering personalized care to RMDD.
我们尚不清楚复发性重度抑郁症（RMDD）是否会影响法国癌症患者的生命终末期（EOL）护理质量。为了填补这一知识空白，我们在一项为期 4 年的全国性队列研究中，比较了死于癌症的 RMDD 患者和无精神障碍患者的 EOL 护理。
全国性队列研究。
法国国家医院数据库。
2013-2016 年在医院死于癌症的所有年龄≥15 岁的患者：4070 名 RMDD 患者和 222477 名对照者。
生命最后 31 天的姑息治疗和生命最后 14 天的高强度 EOL 治疗，包括化疗、人工营养、气管插管、机械通气、胃造口术、心肺复苏、透析、输血、手术、内镜检查、影像学检查、重症监护病房和生命最后 31 天的急诊室入院。使用对数正态分布的多变量广义混合模型比较 RMDD 患者和对照组。
与对照组相比，RMDD 患者的死亡年龄平均年轻 3 岁，合并症更多，胸部癌症更多，转移更少，从癌症诊断到死亡的时间更长。经过匹配和调整后，RMDD 患者接受姑息治疗的比例更高，高强度 EOL 治疗的比例更低，急性护理单元的反复入院次数更少，在重症监护病房和急诊室的死亡率更低。
RMDD 患者更有可能接受姑息治疗，同时接受高强度 EOL 治疗的可能性较低。然而，这种解释可能值得讨论，原因可能是患者/家属的意愿，也可能是提供者难以对 RMDD 患者提供个性化的护理。
