Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, Mexico.
Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, Mexico.
Oncologist. 2021 Feb;26(2):157-164. doi: 10.1002/onco.13599. Epub 2020 Dec 12.
The early integration of supportive care in oncology improves patient-centered outcomes. However, data are lacking regarding how to achieve this in resource-limited settings. We studied whether patient navigation increased access to multidisciplinary supportive care among Mexican patients with advanced cancer.
This randomized controlled trial was conducted between August 2017 and April 2018 at a public hospital in Mexico City. Patients aged ≥18 years with metastatic tumors ≤6 weeks from diagnosis were randomized (1:1) to a patient navigation intervention or usual care. Patients randomized to patient navigation received personalized supportive care from a navigator and a multidisciplinary team. Patients randomized to usual care obtained supportive care referrals from treating oncologists. The primary outcome was the implementation of supportive care interventions at 12 weeks. Secondary outcomes included advance directive completion, supportive care needs, and quality of life.
One hundred thirty-four patients were randomized: 67 to patient navigation and 67 to usual care. Supportive care interventions were provided to 74% of patients in the patient navigation arm versus 24% in usual care (difference 0.50, 95% confidence interval [CI] 0.34-0.62; p < .0001). In the patient navigation arm, 48% of eligible patients completed advance directives, compared with 0% in usual care (p < .0001). At 12 weeks, patients randomized to patient navigation had less moderate/severe pain (10% vs. 33%; difference 0.23, 95% CI 0.07-0.38; p = .006), without differences in quality of life between arms.
Patient navigation improves access to early supportive care, advance care planning, and pain for patients with advanced cancer in resource-limited settings.
The early implementation of supportive care in oncology is recommended by international guidelines, but this might be difficult to achieve in resource-limited settings. This randomized clinical trial including 134 Mexican patients with advanced cancer demonstrates that a multidisciplinary patient navigation intervention can improve the early access to supportive and palliative care interventions, increase advance care planning, and reduce symptoms compared with usual oncologist-guided care alone. These results demonstrate that patient navigation represents a potentially useful solution to achieve the adequate implementation of supportive and palliative care in resource-limited settings globally.
肿瘤学中支持性护理的早期整合可以改善以患者为中心的治疗结果。然而，在资源有限的环境下，如何实现这一目标的数据尚缺乏。我们研究了患者导航是否可以增加墨西哥晚期癌症患者获得多学科支持性护理的机会。
这是一项于 2017 年 8 月至 2018 年 4 月在墨西哥城一家公立医院进行的随机对照试验。纳入年龄≥18 岁、诊断后转移瘤≤6 周的患者，按 1:1 随机分为患者导航干预组或常规护理组。随机分配至患者导航组的患者接受导航员和多学科团队的个性化支持性护理。随机分配至常规护理组的患者由主治肿瘤医生提供支持性护理转诊。主要结局是在 12 周时实施支持性护理干预。次要结局包括预立医疗指示的完成情况、支持性护理需求和生活质量。
共有 134 名患者被随机分组：67 名患者被分配至患者导航组，67 名患者被分配至常规护理组。在患者导航组，74%的患者接受了支持性护理干预，而常规护理组仅为 24%（差异 0.50，95%置信区间[CI] 0.34-0.62；p<0.0001）。在患者导航组，48%的符合条件的患者完成了预立医疗指示，而常规护理组为 0%（p<0.0001）。在 12 周时，随机分配至患者导航组的患者疼痛程度较轻（10% vs. 33%；差异 0.23，95%CI 0.07-0.38；p=0.006），两组生活质量无差异。
在资源有限的环境下，患者导航可改善晚期癌症患者获得早期支持性护理、预先护理计划和疼痛管理的机会。
国际指南建议在肿瘤学中尽早实施支持性护理，但在资源有限的环境下，这可能难以实现。这项纳入 134 名墨西哥晚期癌症患者的随机临床试验表明，多学科患者导航干预可以改善早期获得支持性和姑息性护理干预的机会，增加预先护理计划，并与单纯由主治肿瘤医生指导的护理相比，减轻症状。这些结果表明，患者导航是在全球资源有限的环境下实现支持性和姑息性护理充分实施的一种潜在有效方法。
