Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida.
Department of Nutrition & Dietetics, University of Central Missouri, Warrensburg, MO.
Am J Clin Oncol. 2020 Nov;43(11):806-812. doi: 10.1097/COC.0000000000000748.
The objective of this study was to understand the trends and characteristics of palliative care delivery among critically ill brain metastasis patients using a nationally representative database.
This study was a retrospective analysis of Nationwide Inpatient Sample data collected during 2005 to 2014. This study included critically ill patients, 18 years and above, diagnosed with brain metastasis, identified using International Classification of Diseases-Ninth Revision-Clinical Modification diagnosis and procedure codes. Multivariable logistic regression models were used for predicting factors associated with inpatient palliative care use.
Among 18,309 critically ill patients with brain metastasis, 3298 (18.0%) received inpatient palliative care. The rate of inpatient palliative care use among these patients increased from 3.2% to 28.5%, during 2005 to 2014 (P<0.001). Regression analysis showed that hospital teaching status (odds ratio [ORs], 1.45; 95% confidence interval [CI], 1.14-1.84), primaries located in head and neck (OR, 1.42; 95% CI, 1.21-2.05) or lung (OR, 1.32; 95% CI, 1.22-1.44), and primary diagnosis of pneumonia (OR, 1.42; 95% CI, 1.22-1.97) or septicemia (OR, 1.59; 95% CI, 1.30-1.97), were associated with higher palliative care use. Hispanic ethnicity (OR, 0.86; 95% CI, 0.67-0.96), and hospital location in Northeast (OR, 0.73; 95% CI, 0.54-0.96), Midwest (OR, 0.63; 95% CI, 0.45-0.87), or South (OR, 0.64; 95% CI, 0.48-0.86) were associated with lower palliative care use.
Inpatient palliative care use increased significantly among critically ill patients with brain metastases, though overall rate was low. There were geographical and racial disparities among these patients. Health care providers and policy makers should focus on decreasing these disparities. In addition, hospitals should focus on adopting more palliative care services.
本研究旨在利用全国代表性数据库了解重症脑转移患者姑息治疗的趋势和特征。
这是一项对 2005 年至 2014 年国家住院患者样本数据进行的回顾性分析。本研究纳入了 18 岁及以上被诊断为脑转移的重症患者，使用国际疾病分类第九版临床修订诊断和程序代码进行识别。多变量逻辑回归模型用于预测与住院姑息治疗使用相关的因素。
在 18309 例重症脑转移患者中，有 3298 例（18.0%）接受了住院姑息治疗。2005 年至 2014 年期间，这些患者中接受住院姑息治疗的比例从 3.2%上升至 28.5%（P<0.001）。回归分析显示，医院教学地位（比值比[ORs]，1.45；95%置信区间[CI]，1.14-1.84）、原发部位位于头颈部（OR，1.42；95%CI，1.21-2.05）或肺部（OR，1.32；95%CI，1.22-1.44）以及肺炎（OR，1.42；95%CI，1.22-1.97）或败血症（OR，1.59；95%CI，1.30-1.97）的主要诊断与更高的姑息治疗使用率相关。西班牙裔（OR，0.86；95%CI，0.67-0.96）以及东北部（OR，0.73；95%CI，0.54-0.96）、中西部（OR，0.63；95%CI，0.45-0.87）或南部（OR，0.64；95%CI，0.48-0.86）的医院位置与较低的姑息治疗使用率相关。
尽管总体使用率较低，但重症脑转移患者的住院姑息治疗使用率显著增加。这些患者存在地理和种族差异。医疗保健提供者和政策制定者应关注减少这些差异。此外，医院应专注于采用更多的姑息治疗服务。
