Radiation Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada
Oncology, University of Calgary, Calgary, Alberta, Canada.
BMJ Support Palliat Care. 2023 Oct;13(e1):e144-e149. doi: 10.1136/bmjspcare-2020-002220. Epub 2020 Sep 17.
In 2007, Cancer Care Ontario began standardised symptom assessment as part of routine care using the Edmonton Symptom Assessment System (ESAS).
The purpose of this study was to evaluate the impact of ESAS on receipt of palliative care when compared with a matched group of unexposed patients.
A retrospective-matched cohort study examined the impact of ESAS screening on initiation of palliative care services provided by physicians or homecare nurses. The study included adult patients diagnosed with cancer between 2007 and 2015. Exposure was defined as completing ≥1 ESAS during the study period. Using 4 hard and 14 propensity score-matched variables, patients with cancer exposed to ESAS were matched 1:1 to those who were not. Matched patients were followed from first ESAS until initiation of palliative care, death or end of study.
The final cohort consisted of 204 688 matched patients with no prior palliative care consult. The pairs were well matched. The cumulative incidence of receiving palliative care within the first 5 years was higher among those exposed to ESAS compared with those who were not (27.9% (95% CI: 27.5% to 28.2%) versus 27.9% (95% CI: 27.5% to 28.2%)), when death is considered as a competing event. In the adjusted cause-specific Cox proportional hazards model, ESAS assessment was associated with a 6% increase in palliative care services (HR: 1.06, 95% CI: 1.04 to 1.08).
We have demonstrated that patients exposed to ESAS were more likely to receive palliative care services compared with patients who were not exposed. This observation provides real-world data of the impact of routine assessment with a patient-reported outcome.
2007 年，安大略癌症护理中心开始使用埃德蒙顿症状评估系统（ESAS）对症状进行标准化评估，作为常规护理的一部分。
本研究旨在评估 ESAS 与未暴露于 ESAS 的匹配组患者相比，对接受姑息治疗的影响。
回顾性匹配队列研究评估了 ESAS 筛查对接受医生或家庭护理护士提供的姑息治疗服务的启动的影响。该研究纳入了 2007 年至 2015 年间诊断为癌症的成年患者。暴露定义为在研究期间完成≥1 次 ESAS。使用 4 个硬指标和 14 个倾向评分匹配变量，对接受 ESAS 的癌症患者与未接受 ESAS 的患者进行 1:1 匹配。匹配患者从首次 ESAS 开始，直至开始姑息治疗、死亡或研究结束。
最终队列包括 204688 名无先前姑息治疗咨询的匹配患者。两组患者匹配良好。在首次 5 年内接受姑息治疗的累积发生率在接受 ESAS 评估的患者中高于未接受 ESAS 评估的患者（27.9%（95%CI：27.5%至 28.2%）与 27.9%（95%CI：27.5%至 28.2%）），当将死亡视为竞争事件时。在调整后的特定原因 Cox 比例风险模型中，ESAS 评估与姑息治疗服务增加 6%相关（HR：1.06，95%CI：1.04 至 1.08）。
我们已经证明，与未暴露于 ESAS 的患者相比，接受 ESAS 评估的患者更有可能接受姑息治疗服务。这一观察结果提供了常规评估与患者报告结果相结合对影响的真实世界数据。
