Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA.
Department of Oncology, Sheba Medical Center, Tel-Hashomer, Israel, Tel-Aviv University, Tel-Aviv, Israel.
JCO Oncol Pract. 2020 Aug;16(8):e678-e687. doi: 10.1200/JOP.19.00328. Epub 2020 Mar 4.
The median overall survival (OS) for metastatic pancreatic ductal adenocarcinoma (mPDAC) is < 1 year. Factors that contribute to quality of life during treatment are critical to quantify. One factor-time spent obtaining clinical services-is understudied. We quantified total outpatient time among patients with mPDAC receiving palliative systemic chemotherapy.
We conducted a retrospective analysis using four patient-level time measures calculated from the medical record of patients with mPDAC receiving 5-fluorouracil infusion, leucovorin, oxaliplatin, and irinotecan; gemcitabine/nab-paclitaxel; or gemcitabine within the University of Pennsylvania Health System between January 1, 2011 and January 15, 2019. These included the total number of health care encounter days (any day with at least one visit) and total visit time. Total visit time represented the time spent receiving care (care time) plus time spent commuting and waiting for care (noncare time). We performed descriptive statistics on these outpatient time metrics and compared the number of encounter days to OS.
A total of 362 patients were identified (median age, 65 years; 52% male; 78% white; 62% received gemcitabine plus nab-paclitaxel). Median OS was 230.5 days (7.6 months), with 79% of patients deceased at the end of follow-up. On average, patients had 22 health care encounter days, accounting for 10% of their total days survived. Median visit time was 4.6 hours, of which 2.5 hours was spent commuting or waiting for care.
On average, patients receiving palliative chemotherapy for mPDAC spend 10% of survival time on outpatient health care. More than half of this time is spent commuting and waiting for care. These findings provide an important snapshot of the patient experience during ambulatory care, and efforts to enhance efficiency of care delivery may be warranted.
转移性胰腺导管腺癌（mPDAC）的中位总生存期（OS）<1 年。治疗期间影响生活质量的因素至关重要，需要进行量化。一个因素——获得临床服务所花费的时间——研究不足。我们量化了接受姑息性全身化疗的 mPDAC 患者的总门诊时间。
我们使用从宾夕法尼亚大学健康系统 2011 年 1 月 1 日至 2019 年 1 月 15 日期间接受氟尿嘧啶输注、亚叶酸、奥沙利铂和伊立替康；吉西他滨/纳布紫杉醇；或吉西他滨治疗的 mPDAC 患者的病历中计算的四个患者水平时间测量值进行回顾性分析。这些包括总医疗保健就诊天数（至少有一次就诊的任何一天）和总就诊时间。总就诊时间代表接受治疗的时间（治疗时间）加上通勤和等待治疗的时间（非治疗时间）。我们对这些门诊时间指标进行了描述性统计，并比较了就诊天数与 OS。
共确定了 362 名患者（中位年龄 65 岁；52%为男性；78%为白人；62%接受吉西他滨加纳布紫杉醇治疗）。中位 OS 为 230.5 天（7.6 个月），随访结束时 79%的患者死亡。平均而言，患者有 22 次医疗保健就诊，占其总生存天数的 10%。中位就诊时间为 4.6 小时，其中 2.5 小时用于通勤或等待治疗。
平均而言，接受姑息性化疗治疗 mPDAC 的患者在门诊医疗保健上花费了 10%的生存时间。超过一半的时间用于通勤和等待治疗。这些发现提供了门诊护理期间患者体验的重要快照，需要努力提高护理提供的效率。
