From the Aix-Marseille University, CEReSS-Health Service Research and Quality of Life Center (Fond, Baumstarck, Auquier, Pauly, Bernard, Lancon, Boyer); Department of Medical Information (Fond, Pauly, Orleans, Boyer) and Epidemiology and Health Economics (Fond, Auquier, Boyer), APHM, Marseille; CHU Clermont-Ferrand (Llorca), Clermont-Ferrand, France; and Departments of Psychiatry (Lancon) and Adult Oncology (Salas), APHM, Marseille, France.
Psychosom Med. 2020 Sep;82(7):722-732. doi: 10.1097/PSY.0000000000000839.
This study aimed to describe end-of-life (EOL) care in individuals with bipolar disorder (BD) who died of cancer compared with mentally healthy individuals.
This was a nationwide cohort study of all adult individuals who died of cancer in hospitals in France between 2013 and 2016. Outcomes were compared between individuals with BD and mentally healthy individuals in the last month of life including palliative care and high-intensity EOL care (chemotherapy, artificial nutrition, and other interventions). A subanalysis explored differences between patients with BD and patients with schizophrenia.
The study included 2015 individuals with BD and 222,477 mentally healthy controls. Compared with the controls, individuals with BD died 5 years earlier, more often had comorbidities and thoracic cancer, and had fewer metastases, but did not have shorter delays from cancer diagnosis to death. After matching and adjustment for covariates, individuals with BD more often received palliative care in the last 3 days of life (25% versus 13%, p < .001) and less high-intensity care (e.g., chemotherapy 12% versus 15%, p = .004), but more artificial nutrition (6% versus 4.6%, p = .003). Compared with the schizophrenia comparison group, chemotherapy was received more by individuals with BD in the last 14 days of life (12.5% for BD versus 9.4%, p < .001).
Individuals with BD were more likely to receive palliative care and less likely to receive high-intensity EOL care, except for artificial nutrition. These results may not be specific to BD, as no difference was found between patients with BD and schizophrenia except for chemotherapy.
本研究旨在描述与心理健康个体相比，死于癌症的双相情感障碍（BD）患者的临终关怀情况。
这是一项对 2013 年至 2016 年期间在法国医院死于癌症的所有成年个体进行的全国性队列研究。在生命的最后一个月，对 BD 患者和心理健康个体的结局进行了比较，包括姑息治疗和高强度临终关怀（化疗、人工营养和其他干预措施）。亚分析探讨了 BD 患者与精神分裂症患者之间的差异。
该研究纳入了 2015 名 BD 患者和 222477 名心理健康对照者。与对照组相比，BD 患者的死亡年龄早 5 年，更常患有合并症和胸部癌症，转移灶更少，但从癌症诊断到死亡的时间没有更短。在匹配和调整协变量后，BD 患者在生命的最后 3 天更常接受姑息治疗（25%比 13%，p<0.001），接受高强度治疗的可能性更小（如化疗 12%比 15%，p=0.004），但接受人工营养的可能性更大（6%比 4.6%，p=0.003）。与精神分裂症比较组相比，BD 患者在生命的最后 14 天更常接受化疗（BD 患者 12.5%比 9.4%，p<0.001）。
BD 患者更有可能接受姑息治疗，而不太可能接受高强度临终关怀，除了人工营养。这些结果可能不仅限于 BD，因为除了化疗外，BD 患者与精神分裂症患者之间没有差异。
