Unité Mobile de Soins Palliatifs, Hôpital Cochin, AP-HP Centre, Paris, France.
Université de Paris, Public Health, Paris, France.
BMC Palliat Care. 2020 Mar 12;19(1):31. doi: 10.1186/s12904-020-0539-x.
Palliative care (PC) referral is recommended early in the course of advanced cancer. This study aims to describe, in an integrated onco-palliative care program (IOPC), patient's profile when first referred to this program, timing of this referral and its impact on the trajectory of care at end-of-life.
The IOPC combined the weekly onco-palliative meeting (OPM) dedicated to patients with incurable cancer, and/or the clinical evaluation by the PC team. Oncologists can refer to the multidisciplinary board of the OPM the patients for whom goals and organization of care need to be discussed. We analyzed all patients first referred at OPM in 2011-2013. We defined the index of precocity (IP), as the ratio of the time from first referral to death by the time from diagnosis of incurability to death, ranging from 0 (late referral) to 1 (early referral).
Of the 416 patients included, 57% presented with lung, urothelial cancers, or sarcoma. At first referral to IOPC, 76% were receiving antitumoral treatment, 63% were outpatients, 56% had a performance status ≤2 and 46% had a serum albumin level > 35 g/l. The median [1st-3rd quartile] IP was 0.39 [0.16-0.72], ranging between 0.53 [0.20-0.79] (earliest referral, i.e. close to diagnosis of incurability, for lung cancer) to 0.16 [0.07-0.56] (latest referral, i.e. close to death relatively to length of metastatic disease, for prostate cancer). Among 367 decedents, 42 (13%) received antitumoral treatment within 14 days before death, and 157 (43%) died in PC units.
The IOPC is an effective organization to enable early integration of PC and decrease aggressiveness of care near the end-of life. The IP is a useful tool to model the timing of referral to IOPC, while taking into account each cancer types and therapeutic advances.
在晚期癌症的病程中，建议尽早进行姑息治疗（PC）转介。本研究旨在描述综合肿瘤姑息治疗计划（IOPC）中，首次转介至该计划的患者特征、转介时间及其对临终关怀轨迹的影响。
IOPC 结合了每周一次的针对无法治愈的癌症患者的肿瘤姑息治疗会议（OPM），以及姑息治疗团队的临床评估。肿瘤医生可以将需要讨论治疗目标和组织的患者提交给 OPM 的多学科委员会。我们分析了 2011 年至 2013 年期间在 OPM 首次转介的所有患者。我们定义了早熟指数（IP），即从首次转介到死亡的时间与从不可治愈诊断到死亡的时间之比，范围从 0（晚期转介）到 1（早期转介）。
在纳入的 416 名患者中，57%患有肺癌、尿路上皮癌或肉瘤。在首次转介至 IOPC 时，76%正在接受抗肿瘤治疗，63%为门诊患者，56%的表现状态≤2，46%的血清白蛋白水平>35g/l。中位数[1 四分位数-3 四分位数]的 IP 为 0.39[0.16-0.72]，范围为 0.53[0.20-0.79]（最早转介，即接近不可治愈诊断，用于肺癌）至 0.16[0.07-0.56]（最晚转介，即接近死亡相对于转移性疾病的长度，用于前列腺癌）。在 367 名死亡患者中，42 名（13%）在死亡前 14 天内接受抗肿瘤治疗，157 名（43%）在姑息治疗单位死亡。
IOPC 是一种有效的组织方式，可以实现 PC 的早期整合，并减少临终关怀末期的治疗强度。IP 是一种有用的工具，可以在考虑每种癌症类型和治疗进展的情况下，对转介至 IOPC 的时间进行建模。
