Tanguy-Melac Audrey, Denis Pierre, Pestel Laurence, Fagot-Campagna Anne, Gastaldi-Ménager Christelle, Tuppin Philippe
Caisse nationale d'assurance maladie (CNAM), direction de la stratégie des études et des statistiques, 26-50, avenue du Professeur André-Lemierre, 75986 Paris cedex 20, France.
Caisse nationale d'assurance maladie (CNAM), direction de la stratégie des études et des statistiques, 26-50, avenue du Professeur André-Lemierre, 75986 Paris cedex 20, France.
Bull Cancer. 2020 Mar;107(3):308-321. doi: 10.1016/j.bulcan.2019.11.011. Epub 2020 Feb 5.
Health care utilization of people with lung cancer (LC) the last year of life, their causes of death and place of death and the associated expenditure have been poorly described together. Then we conducted an observational study.
People with LC covered by the French health Insurance general scheme (77% of the population) who died in 2015 were identified in the national health data system, together with their health care utilization and, in 95% of cases, their causes of death.
A total of 22,899 individuals were included (mean age: 68 years, SD±11.4), 72% of whom died in short-stay hospitals (SSH), 4% in hospital-at-home, 8% in Rehab hospital, 2% in skilled nursing homes and 14% at home. One-half of these people had also a chronic respiratory tract disease and 18% another cancer. Hospital palliative care (HPC) was identified for 65% of people, but for only 9% prior to their end-of-life stay. During the last month of life, 49% of people had two or more SSH stays, 15% were admitted to an intensive care unit, 23% received a chemotherapy session (13% during the last 14 days). The main cause of death was cancer for 92% of individuals (LC for 82%) The mean expenditure during the last year of life was €43,329 per individual.
This study indicates high rates of intensive care unit admissions and chemotherapy during the last month of life and a SSH hospital-centered management with intensive use of HPC mainly during the end-of-life stay.
肺癌患者在生命最后一年的医疗保健利用情况、死亡原因、死亡地点以及相关支出，此前一直缺乏全面的描述。因此，我们开展了一项观察性研究。
在国家卫生数据系统中识别出2015年死亡的、纳入法国医疗保险一般计划（覆盖77%的人口）的肺癌患者，以及他们的医疗保健利用情况，在95%的病例中还包括死亡原因。
共纳入22899名个体（平均年龄：68岁，标准差±11.4），其中72%在短期住院医院（SSH）死亡，4%在家住院死亡，8%在康复医院死亡，2%在专业护理院死亡，14%在家中死亡。这些患者中有一半还患有慢性呼吸道疾病，18%患有另一种癌症。65%的患者接受过医院姑息治疗（HPC），但仅9%在临终住院前接受过。在生命的最后一个月，49%的患者有两次或更多次SSH住院，15%入住重症监护病房，23%接受过化疗疗程（13%在最后14天内）。92%的个体主要死亡原因是癌症（82%是肺癌）。生命最后一年的平均支出为每人43329欧元。
本研究表明，在生命的最后一个月，重症监护病房入住率和化疗率较高，且以SSH医院为中心进行管理，主要在临终住院期间大量使用HPC。
