Aix Marseille Univ, INSERM, IRD, Economics and Social Sciences Applied to Health & Analysis of Medical Information (SESSTIM), 27 Boulevard Jean Moulin, Marseille, France.
Department of Health Data and Assessment, Survey Data Science and Assessment Division, French National Cancer Institute (Institut National du Cancer INCa), 52 Avenue André Morizet, Boulogne-Billancourt, France.
BMC Health Serv Res. 2020 Aug 26;20(1):798. doi: 10.1186/s12913-020-05667-8.
Closely linked to the concept of supportive care, the integrated model of palliative care (PC) implies identifying, assessing and treating physical and psychological suffering as early as needed, irrespective of patient characteristics. In France, as in the most southern European countries, little is known about the proportion of cancer patients who have access to PC. Accordingly, we aimed in this study to estimate the proportion of cancer patients in France who have access to inpatient PC, and to explore associated factors. We carried out a nationwide retrospective cohort study using data from the French national health system database (SNDS) for all individuals diagnosed with cancer in 2013 and followed between 2013 and 2016. We compared patients who had inpatient PC with those who did not.
Of the 313,059 cancer patients included in the national French cancer cohort in 2013, 53,437 (17%) accessed inpatient PC at least once between 2013 and 2016, ranging from 2% in survivors to 56% in the deceased population. Multivariate logistic regression revealed that women and younger patients (18-49 years old) were less likely to access inpatient PC while patients with a greater number of comorbidities, metastatic cancer, or cancer of the nervous system, were more likely to have done so.
A negligible proportion of cancer survivors accessed inpatient PC. More research and training are needed to convince healthcare providers, patients, and families about the substantial benefits of PC, and to promote better integration of PC and oncology.
姑息治疗（PC）的综合模式与支持性护理密切相关，它意味着尽早识别、评估和治疗身体和心理痛苦，无论患者的特征如何。在法国，与大多数南欧国家一样，人们对接受姑息治疗的癌症患者的比例知之甚少。因此，我们旨在本研究中估计法国癌症患者接受住院姑息治疗的比例，并探讨相关因素。我们使用 2013 年诊断为癌症的所有个体的法国国家卫生系统数据库（SNDS）中的数据，开展了一项全国性回顾性队列研究，并在 2013 年至 2016 年间对这些个体进行了随访。我们将接受住院姑息治疗的患者与未接受住院姑息治疗的患者进行了比较。
在 2013 年纳入法国全国癌症队列的 313059 例癌症患者中，有 53437 例（17%）在 2013 年至 2016 年间至少接受过一次住院姑息治疗，从幸存者中的 2%到死亡患者中的 56%不等。多变量逻辑回归显示，女性和年轻患者（18-49 岁）不太可能接受住院姑息治疗，而合并症较多、转移性癌症或神经系统癌症的患者更有可能接受住院姑息治疗。
极少数癌症幸存者接受了住院姑息治疗。需要进一步研究和培训，以使医疗保健提供者、患者和家属相信姑息治疗的实质性益处，并促进姑息治疗和肿瘤学更好地整合。
