Department of Urology, Institute of Urologic Oncology (IUO), David Geffen School of Medicine, University of California, Los Angeles, CA.
Department of Urology, Institute of Urologic Oncology (IUO), David Geffen School of Medicine, University of California, Los Angeles, CA.
Urol Oncol. 2020 Nov;38(11):854.e1-854.e9. doi: 10.1016/j.urolonc.2020.04.029. Epub 2020 May 17.
Palliative care has an established role in improving the quality of life in patients with advanced cancer, but little is known regarding its delivery among patients with urologic malignancies.
To determine trends in the utilization of palliative interventions among patients with advanced bladder, prostate, and kidney cancer.
DESIGN, SETTING, AND PARTICIPANTS: We performed a retrospective cohort study of patients from years 2004 to 2013 in the National Cancer Database diagnosed with stage IV bladder (n = 17,997), prostate (n = 23,322), and kidney (n = 34,697) cancer, after excluding those with missing disease stage, treatment, and outcomes data.
Descriptive statistics and logistic regression were performed to evaluate utilization of palliative care intervention. Utilization was analyzed by cancer type and by overall survival strata (<6, 6-24, and >24 months). Kaplan-Meier and Cox proportional hazards models analyzed overall survival.
Palliative interventions were utilized in 12.5% (2,257/17,997), 14.7% (3,442/23,322), and 19.9% (6,935/34,697) of advanced bladder, prostate, and kidney cancer patients, respectively. Older age and longer survival were associated with lower odds of palliative intervention utilization in each malignancy, as was minority race in kidney and bladder cancer patients. Palliative radiation was used most commonly, and utilization of any palliative intervention was associated with poorer overall survival. Limitations largely stem from imperfect data abstraction, and the analysis of interventions' incomplete reflection of palliative care.
Palliative interventions were seldom used among patients with advanced urologic malignancies. Palliative interventions were less frequently used in older patients and minority races. Further study is warranted to define the role of palliative interventions in advanced urologic malignancies and guide their utilization.
姑息治疗在改善晚期癌症患者的生活质量方面具有既定的作用，但对于泌尿科恶性肿瘤患者的姑息治疗的实施情况却知之甚少。
确定晚期膀胱癌、前列腺癌和肾癌患者姑息治疗干预措施的利用趋势。
设计、设置和参与者：我们对 2004 年至 2013 年间国家癌症数据库中诊断为 IV 期膀胱癌（n=17997）、前列腺癌（n=23322）和肾癌（n=34697）的患者进行了回顾性队列研究，排除了那些缺乏疾病分期、治疗和结局数据的患者。
采用描述性统计和逻辑回归来评估姑息治疗干预措施的利用情况。根据癌症类型和总生存分层（<6、6-24 和>24 个月）来分析姑息治疗的利用情况。Kaplan-Meier 和 Cox 比例风险模型分析了总生存情况。
姑息治疗干预措施分别在 12.5%（2257/17997）、14.7%（3442/23322）和 19.9%（6935/34697）的晚期膀胱癌、前列腺癌和肾癌患者中得到了应用。在每种恶性肿瘤中，年龄较大和生存时间较长与姑息治疗干预措施的利用可能性降低相关，而少数族裔在肾癌和膀胱癌患者中也是如此。姑息性放疗的应用最为普遍，任何姑息治疗干预措施的应用都与较差的总体生存相关。主要局限性在于数据提取不完美，以及干预措施不能完全反映姑息治疗。
晚期泌尿科恶性肿瘤患者姑息治疗干预措施的应用很少。姑息治疗干预措施在老年患者和少数族裔中较少使用。需要进一步研究以确定姑息治疗干预措施在晚期泌尿科恶性肿瘤中的作用，并指导其应用。
