Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts.
Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Cancer. 2020 Jun 15;126(12):2924-2933. doi: 10.1002/cncr.32833. Epub 2020 Mar 13.
Inpatient supportive care programs often target patients with advanced solid tumors. To the authors' knowledge, few studies to date have characterized symptom burden in hospitalized patients with potentially curable cancers. The objective of the current study was to compare symptom burden, palliative care consultation, and readmission rates in hospitalized patients by cancer type and treatment intent.
The authors conducted a single-center study of hospitalized patients with cancer between 2014 and 2017. They assessed physical symptoms using the Edmonton Symptom Assessment System and psychological distress using the Patient Health Questionnaire-4 and the Primary Care PTSD (Posttraumatic Stress Disorder) Screen. Multivariate linear regression models were used to assess symptom burden, logistic regression was used to assess palliative care use, and competing risk regression was used to compare 90-day readmission risk.
A total of 1549 patients were enrolled and surveyed. The majority of patients reported moderate to severe fatigue, poor well-being, and drowsiness with no significant differences noted by cancer type and treatment intent. Compared with other groups, patients with incurable solid cancer reported higher physical symptoms (beta coefficient [B], 4.73; P < .01) and symptoms of depression (B, 0.44; P < .01) and anxiety (B, 0.39; P < .01), but no difference in posttraumatic stress disorder. Among patients in the top quartile symptom burden according to the Edmonton Symptom Assessment System, the palliative care service was consulted in 14.7%, 7.9%, 25.0%, and 49.6%, respectively, of patients with potentially curable hematologic, potentially curable solid, incurable hematologic, and incurable solid cancers (P < .001). Compared with patients with potentially curable solid cancer, patients in each group experienced a higher risk of readmission within 90 days.
Hospitalized patients with cancer experience substantial physical and psychological symptoms. Palliative care rarely is consulted for highly symptomatic patients with potentially curable cancers. Supportive care interventions should target the needs of symptomatic patients regardless of treatment intent.
住院患者支持性护理计划通常针对晚期实体瘤患者。据作者所知，迄今为止，很少有研究描述有治愈可能的癌症住院患者的症状负担。本研究的目的是比较不同癌症类型和治疗意图的住院患者的症状负担、姑息治疗咨询和再入院率。
作者于 2014 年至 2017 年期间对癌症住院患者进行了一项单中心研究。他们使用埃德蒙顿症状评估系统评估身体症状，使用患者健康问卷-4 和初级保健创伤后应激障碍（Posttraumatic Stress Disorder，PTSD）筛查量表评估心理困扰。多变量线性回归模型用于评估症状负担，逻辑回归用于评估姑息治疗的使用，竞争风险回归用于比较 90 天再入院风险。
共纳入并调查了 1549 名患者。大多数患者报告有中度至重度疲劳、健康状况不佳和嗜睡，但按癌症类型和治疗意图分组，没有明显差异。与其他组相比，患有不可治愈实体癌的患者报告的身体症状更严重（β系数[B]，4.73；P<.01）和抑郁症状（B，0.44；P<.01）和焦虑症状（B，0.39；P<.01），但 PTSD 无差异。根据埃德蒙顿症状评估系统，症状负担最高的患者中有 14.7%、7.9%、25.0%和 49.6%的患者分别咨询了姑息治疗服务，患有有治愈可能的血液系统、有治愈可能的实体癌、不可治愈的血液系统和不可治愈的实体癌（P<.001）。与有治愈可能的实体癌患者相比，每个组中的患者在 90 天内再入院的风险更高。
癌症住院患者经历了大量的身体和心理症状。姑息治疗很少为有治愈可能的癌症高度症状患者提供咨询。支持性护理干预措施应针对有症状患者的需求，而不论其治疗意图如何。
