Allen Michael J, Dunn Nathan, Guan Tracey, Harrington John, Walpole Euan
Division of Cancer Services, Princess Alexandra Hospital, Queensland Health, Brisbane, Queensland, Australia.
School of Medicine, University of Queensland, Brisbane, Queensland, Australia.
Intern Med J. 2022 Apr;52(4):623-632. doi: 10.1111/imj.15107.
End-of-life (EOL) chemotherapy administration rates for solid tumours are 12-20% and are associated with a reduced quality of life, increased hospitalisation and incidence of death within an acute care facility.
We sought to determine the rate of EOL chemotherapy in government and private hospitals and determine the impact on hospitalisations and location of death in lung and pancreatic cancer patients.
Data were obtained from the Queensland Oncology Repository between 2005 and 2014. Lung (n = 16 501) and pancreatic cancer (n = 4144) deaths were analysed. EOL chemotherapy was determined to be within 30 days of death. Demographics, location of treatment and death are reported.
Chemotherapy was administered to 6518 (40%) lung cancer and 1694 (41%) pancreatic cancer patients. A total of 1474 (9%) and 477 (12%) patients, respectively, received EOL chemotherapy. EOL chemotherapy was more common in males and those with distant metastatic disease, while less likely in the elderly and those with a lower socioeconomic status. EOL chemotherapy was more prevalent in large hospitals and was more common in private compared with government hospitals for pancreatic cancer (30 vs 26%; P < 0.001), while it was similar for lung cancer (24 vs 22%; P = 0.115). Death after EOL chemotherapy compared with all cancer deaths was more common in an acute care facility (lung cancer: 60 vs 37%; P < 0.001; pancreatic cancer: 53 vs 36%; P < 0.001).
EOL chemotherapy rates were similar to Australian yet marginally lower than international rates, with variation dependent on the size and type of facility and increased the rate of deaths within an acute care facility.
实体瘤临终化疗给药率为12%-20%，且与生活质量下降、住院率增加以及在急性护理机构内的死亡发生率相关。
我们试图确定政府医院和私立医院的临终化疗率，并确定其对肺癌和胰腺癌患者住院率及死亡地点的影响。
数据取自2005年至2014年昆士兰肿瘤库。分析了肺癌（n = 16501）和胰腺癌（n = 4144）患者的死亡情况。临终化疗被确定为在死亡前30天内进行。报告了人口统计学数据、治疗地点和死亡地点。
6518名（40%）肺癌患者和1694名（41%）胰腺癌患者接受了化疗。分别有1474名（9%）和477名（12%）患者接受了临终化疗。临终化疗在男性和有远处转移疾病的患者中更为常见，而在老年人和社会经济地位较低的患者中可能性较小。临终化疗在大型医院更为普遍，对于胰腺癌患者，私立医院比政府医院更常见（30%对26%；P < 0.001），而对于肺癌患者则相似（24%对22%；P = 0.115）。与所有癌症死亡相比，临终化疗后在急性护理机构死亡更为常见（肺癌：60%对37%；P < 0.001；胰腺癌：53%对36%；P < 0.001）。
临终化疗率与澳大利亚相似，但略低于国际水平，其差异取决于机构的规模和类型，并增加了急性护理机构内的死亡率。
