Karl Landsteiner Privatuniversitat fur Gesundheitswissenschaften, Krems, Austria.
Department of Medicine I, Medical University of Vienna, Wien, Austria.
ESMO Open. 2020 Sep;5(5):e000905. doi: 10.1136/esmoopen-2020-000905.
Patients with metastatic breast cancer (MBC) have a considerable symptom burden and may require extensive care for a long period of time. Palliative care (PC) has the potential to improve their quality of care and reduce their use of medical services. However, the role of specialised PC (SPC) in patients with MBC remains unclear.
We performed a retrospective analysis of the medical records of patients diagnosed with breast cancer (BC) from 2008 to 2018 at an university-based referral centre to examine the extent of early and late integration of SPC services for patients with MBC. A descriptive analysis of the patients was also established.
In all, 932 patients were diagnosed with BC from 2008 to 2018; 225 of these patients had or developed metastases related to their BC. In addition, 132 patients received SPC (58.7%) and 93 patients did not receive SPC (41.3%). The median probability of overall survival (OS) for patients who did not receive SPC services was 3.6 years (95% CI 2.0 to 5.1) and 1.8 years (95% CI 1.3 to 2.3) (p<0.0001) for patients who did receive SPC. In multivariate analysis, referral to SPC services was independently associated with OS (HR 1.60, 95% CI 1.16 to 2.22, p=0.004).
Patients who received SPC lived significantly shorter amounts of time than patients not referred for SPC services at our hospital. We concluded that the referral to SPC services was often too late and should be implemented earlier in the course of the disease. We suggest that patients with MBC should participate in a consultation by a SPC team ≤60 days after the start of systemic palliative anticancer therapy in addition to endocrine treatment. Larger prospective studies are needed to evaluate the benefit of the early integration of SPC services for patients with MBC.
转移性乳腺癌（MBC）患者的症状负担相当大，可能需要长期的广泛护理。姑息治疗（PC）有可能改善他们的护理质量并减少他们对医疗服务的使用。然而，MBC 患者的专门 PC（SPC）的作用仍不清楚。
我们对一家大学转诊中心 2008 年至 2018 年诊断为乳腺癌（BC）的患者的病历进行了回顾性分析，以检查 MBC 患者 SPC 服务的早期和晚期整合程度。还对患者进行了描述性分析。
在 2008 年至 2018 年期间，共有 932 名患者被诊断为 BC，其中 225 名患者患有或发展了与 BC 相关的转移灶。此外，132 名患者接受了 SPC（58.7%），93 名患者未接受 SPC（41.3%）。未接受 SPC 服务的患者的总体生存（OS）中位数概率为 3.6 年（95%CI 2.0 至 5.1），而接受 SPC 服务的患者为 1.8 年（95%CI 1.3 至 2.3）（p<0.0001）。在多变量分析中，向 SPC 服务转诊与 OS 独立相关（HR 1.60，95%CI 1.16 至 2.22，p=0.004）。
在我们的医院，接受 SPC 的患者的生存时间明显短于未接受 SPC 服务的患者。我们得出的结论是，向 SPC 服务的转诊往往太晚，应该在疾病过程的早期实施。我们建议，MBC 患者应在开始系统姑息性抗癌治疗和内分泌治疗后≤60 天内参加 SPC 团队的咨询。需要更大的前瞻性研究来评估 MBC 患者早期整合 SPC 服务的益处。
