Department of Oncology and Palliative Medicine, Nordland Hospital Trust, PO Box 1480, 8092, Bodø, Norway.
Institute of Community Medicine, The Arctic University of Norway, PO Box 6, 9038, Tromsø, Norway.
BMC Palliat Care. 2020 Jun 1;19(1):76. doi: 10.1186/s12904-020-00579-0.
Anticancer treatment exposes patients to negative consequences such as increased toxicity and decreased quality of life, and there are clear guidelines recommending limiting use of aggressive anticancer treatments for patients near end of life. The aim of this study is to investigate the association between anticancer treatment given during the last 30 days of life and adverse events contributing to death and elucidate how adverse events can be used as a measure of quality and safety in end-of-life cancer care.
Retrospective cohort study of 247 deceased hospitalised cancer patients at three hospitals in Norway in 2012 and 2013. The Global Trigger Tool method were used to identify adverse events. We used Poisson regression and binary logistic regression to compare adverse events and association with use of anticancer treatment given during the last 30 days of life.
30% of deceased hospitalised cancer patients received some kind of anticancer treatment during the last 30 days of life, mainly systemic anticancer treatment. These patients had 62% more adverse events compared to patients not being treated last 30 days, 39 vs. 24 adverse events per 1000 patient days (p < 0.001, OR 1.62 (1.23-2.15). They also had twice the odds of an adverse event contributing to death compared to patients without such treatment, 33 vs. 18% (p = 0.045, OR 1.85 (1.01-3.36)). Receiving follow up by specialist palliative care reduced the rate of AEs per 1000 patient days in both groups by 29% (p = 0.02, IRR 0.71, CI 95% 0.53-0.96).
Anticancer treatment given during the last 30 days of life is associated with a significantly increased rate of adverse events and related mortality. Patients receiving specialist palliative care had significantly fewer adverse events, supporting recommendations of early integration of palliative care in a patient safety perspective.
抗癌治疗会使患者面临毒性增加和生活质量下降等负面后果，因此有明确的指南建议限制在生命末期使用积极的抗癌治疗。本研究旨在探讨生命最后 30 天内接受的抗癌治疗与导致死亡的不良事件之间的关联，并阐明如何将不良事件作为生命末期癌症护理质量和安全性的衡量标准。
这是一项在挪威的 3 家医院于 2012 年至 2013 年期间进行的 247 名死亡住院癌症患者的回顾性队列研究。使用全球触发工具方法来识别不良事件。我们使用泊松回归和二项逻辑回归来比较不良事件与生命最后 30 天内接受的抗癌治疗之间的关联。
30%的死亡住院癌症患者在生命最后 30 天内接受了某种抗癌治疗，主要是系统抗癌治疗。与未接受生命最后 30 天治疗的患者相比，这些患者发生不良事件的比例增加了 62%，每 1000 个患者日发生 39 次与 24 次不良事件（p<0.001，OR 1.62（1.23-2.15））。与未接受此类治疗的患者相比，他们发生导致死亡的不良事件的可能性也增加了一倍，分别为 33%和 18%（p=0.045，OR 1.85（1.01-3.36））。接受专科姑息治疗随访可使两组的不良事件发生率分别降低 29%（p=0.02，IRR 0.71，95%CI 0.53-0.96）。
生命最后 30 天内接受的抗癌治疗与不良事件发生率和相关死亡率显著增加相关。接受专科姑息治疗的患者不良事件明显减少，这支持了从患者安全角度出发，尽早将姑息治疗纳入的建议。
