慢性阻塞性肺疾病或肺癌患者临终关怀的比较：一项系统综述。

Comparison of end-of-life care in people with chronic obstructive pulmonary disease or lung cancer: A systematic review.

作者信息

Butler Stacey J, Ellerton Lauren, Gershon Andrea S, Goldstein Roger S, Brooks Dina

机构信息

Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada.

Sunnybrook Research Institute, Toronto, ON, Canada.

出版信息

Palliat Med. 2020 Sep;34(8):1030-1043. doi: 10.1177/0269216320929556. Epub 2020 Jun 2.

DOI:10.1177/0269216320929556

PMID:32484762

Abstract

BACKGROUND

Palliative care has been widely implemented in clinical practice for patients with cancer but is not routinely provided to people with chronic obstructive pulmonary disease.

AIM

The study aims were to compare palliative care services, medications, life-sustaining interventions, place of death, symptom burden and health-related quality of life among chronic obstructive pulmonary disease and lung cancer populations.

DESIGN

Systematic review with meta-analysis (PROSPERO: CRD42019139425).

DATA SOURCES

MEDLINE, EMBASE, PubMed, CINAHL and PsycINFO were searched for studies comparing palliative care, symptom burden or health-related quality of life among chronic obstructive pulmonary disease, lung cancer or populations with both conditions. Quality scores were assigned using the QualSyst tool.

RESULTS

Nineteen studies were included. There was significant heterogeneity in study design and sample size. A random effects meta-analysis ( = 3-7) determined that people with lung cancer had higher odds of receiving hospital (odds ratio: 9.95, 95% confidence interval: 6.37-15.55, < 0.001) or home-based palliative care (8.79, 6.76-11.43, < 0.001), opioids (4.76, 1.87-12.11, = 0.001), sedatives (2.03, 1.78-2.32, < 0.001) and dying at home (1.47, 1.14-1.89, = 0.003) compared to people with chronic obstructive pulmonary disease. People with lung cancer had lower odds of receiving invasive ventilation (0.26, 0.22-0.32, < 0.001), non-invasive ventilation (0.63, 0.44-0.89, = 0.009), cardiopulmonary resuscitation (0.29, 0.18-0.47, < 0.001) or dying at a nursing home/long-term care facility (0.32, 0.16-0.64, < 0.001) than people with chronic obstructive pulmonary disease. Symptom burden and health-related quality of life were relatively similar between the two populations.

CONCLUSION

People with chronic obstructive pulmonary disease receive less palliative measures at the end of life compared to people with lung cancer, despite a relatively similar symptom profile.

摘要

背景

姑息治疗已在癌症患者的临床实践中广泛实施，但慢性阻塞性肺疾病患者并未常规接受姑息治疗。

目的

本研究旨在比较慢性阻塞性肺疾病患者和肺癌患者在姑息治疗服务、药物、维持生命的干预措施、死亡地点、症状负担以及与健康相关的生活质量方面的差异。

设计

系统评价与荟萃分析（国际前瞻性系统评价注册库：CRD42019139425）。

数据来源

检索了MEDLINE、EMBASE、PubMed、CINAHL和PsycINFO数据库，以查找比较慢性阻塞性肺疾病、肺癌或同时患有这两种疾病的人群在姑息治疗、症状负担或与健康相关的生活质量方面的研究。使用QualSyst工具分配质量评分。

结果

纳入了19项研究。研究设计和样本量存在显著异质性。随机效应荟萃分析（I² = 3 - 7）确定，与慢性阻塞性肺疾病患者相比，肺癌患者接受住院姑息治疗（优势比：9.95，95%置信区间：6.37 - 15.55，P < 0.001）或居家姑息治疗（8.79，6.76 - 11.43，P < 0.001）、使用阿片类药物（4.76，1.87 - 12.11，P = 0.001）、镇静剂（2.03，1.78 - 2.32，P < 0.001）以及在家中死亡（1.47，1.14 - 1.89，P = 0.003）的几率更高。与慢性阻塞性肺疾病患者相比，肺癌患者接受有创通气（0.26，0.22 - 0.32，P < 0.001）、无创通气（0.63，0.44 - 0.89，P = 0.009）、心肺复苏（0.29，0.18 - 0.47，P < 0.001）或在养老院/长期护理机构死亡（0.32，0.16 - 0.64，P < 0.001）的几率更低。两组人群的症状负担和与健康相关的生活质量相对相似。