Department of Oncology, McMaster University, Hamilton, Ontario, Canada.
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
Psychooncology. 2021 Jan;30(1):103-110. doi: 10.1002/pon.5559. Epub 2020 Oct 13.
Understanding the end-of-life psychosocial needs of cancer patients at home is a knowledge gap. This study describes the trajectory of psychosocial symptoms in the last 6 months of life among cancer decedents who were receiving home care.
Observational population-based cohort study of cancer decedents who were receiving home care services between 2007 and 2014. Decedents had to have at least one home care assessment in the last 6 months of life for inclusion. Outcomes were the presence of psychosocial symptoms (i.e., anxiety, loneliness, depression, social decline, caregiver distress, and cognitive decline) at each week before death.
Our cohort included 27,295 unique cancer decedents (30,368 assessments), of which 58% died in hospital. Fifty-six percent were older than 74, and 47% were female. The prevalence of all symptoms increased approaching death, except loneliness. Social decline (48%-78%) was the most prevalent psychosocial symptom, though loneliness was reported in less than 10% of the cohort. Caregiver distress rose over time from 15%-27%. A third of the cohort reported issues with cognitive impairment. Multivariate regression showed that physical symptoms such as uncontrolled pain, impairment in independent activities of daily living, and a high level of health instability all significantly worsened the odds of having a psychosocial symptom in the last 3 months of life.
In this large home care cancer cohort, trajectories of psychosocial symptoms worsened close to death. Physical symptoms, such as uncontrolled pain, were associated with having worse psychosocial symptoms at end of life.
了解在家中接受治疗的癌症患者临终前的心理社会需求是一个知识空白。本研究描述了在 2007 年至 2014 年间接受家庭护理服务的癌症死亡患者在生命的最后 6 个月中心理社会症状的轨迹。
对在生命的最后 6 个月内至少接受过一次家庭护理评估的接受家庭护理服务的癌症死亡患者进行观察性基于人群的队列研究。结局为在死亡前的每一周是否存在心理社会症状（即焦虑、孤独、抑郁、社会衰退、照顾者痛苦和认知能力下降）。
我们的队列包括 27295 名独特的癌症死亡患者（30368 次评估），其中 58%在医院死亡。56%的患者年龄大于 74 岁，47%为女性。除孤独感外，所有症状的患病率在接近死亡时均增加。社会衰退（48%-78%）是最常见的心理社会症状，但在不到 10%的患者中报告了孤独感。照顾者痛苦随着时间的推移从 15%上升到 27%。三分之一的患者报告存在认知障碍问题。多变量回归显示，无控制的疼痛、独立日常生活活动受损以及健康不稳定程度高等身体症状均显著增加了在生命的最后 3 个月中出现心理社会症状的可能性。
在这个大型家庭护理癌症队列中，心理社会症状的轨迹在接近死亡时恶化。无控制的疼痛等身体症状与临终时出现更严重的心理社会症状相关。
