Monier Pierre Antoine, Chrusciel Jan, Ecarnot Fiona, Bruera Eduardo, Sanchez Stephane, Barbaret Cecile
Department of Supportive and Palliative Care, Centre Hospitalo-Universitaire de Grenoble, Grenoble, France.
Department of Public Health and Performance, Hôpitaux Champagne Sud, Troyes, France.
BMJ Support Palliat Care. 2020 Dec 21. doi: 10.1136/bmjspcare-2020-002641.
Previous studies have found an association between aggressive cancer care and lower quality end of life. Despite international recommendations, late or very late referral to palliative care seems frequent. This study aimed to evaluate the association between the duration of involvement of a palliative care team (PCT), and aggressive cancer care, and to identify factors associated with aggressive cancer care.
We performed an observational retrospective study in a single academic teaching hospital. In total, 561 inpatients with solid tumours or haematological malignancies were included. Patients followed by a PCT for at least 1 month before death were classified in the palliative care group. Aggressive cancer care was defined as: hospitalisations and/or a new line of chemotherapy within the last month of life, location of death, the use of chemotherapy in the last 2 weeks and hospice admissions within the last 3 days of life.
Among the 561 patients, 241 (43%) were referred to the PCT; 89 (16%) were followed by the PCT for a month or more before death. In the last 2 weeks of life, 124 (22%) patients received chemotherapy, 110 (20%) died in an acute care unit. At least one criterion of aggressive cancer care was found in 395 patients overall (71%). Aggressive cancer care was significantly less frequent when the PCT referral occurred >1 month before death (p<0.0001).
More studies are needed to understand reasons for late referrals despite international recommendations encouraging integrative palliative care.
The study was approved by the Grenoble Teaching Hospital ethics committee, and by the CNIL (French national commission for data privacy; Commission Nationale de l'Informatique et des Libertés) under the number 1987785 v 0. Due to ethical and legal restrictions, data are only available on request.
既往研究发现积极的癌症治疗与较低质量的生命末期之间存在关联。尽管有国际推荐意见，但晚期或极晚期转诊至姑息治疗的情况似乎很常见。本研究旨在评估姑息治疗团队（PCT）参与的持续时间与积极的癌症治疗之间的关联，并确定与积极的癌症治疗相关的因素。
我们在一家学术教学医院进行了一项观察性回顾性研究。总共纳入了561例实体瘤或血液系统恶性肿瘤的住院患者。在死亡前至少接受PCT随访1个月的患者被归类为姑息治疗组。积极的癌症治疗定义为：在生命的最后一个月内住院和/或进行新的化疗方案、死亡地点、在生命的最后2周内使用化疗以及在生命的最后3天内入住临终关怀机构。
在561例患者中，241例（43%）被转诊至PCT；89例（16%）在死亡前接受PCT随访1个月或更长时间。在生命的最后2周内，124例（22%）患者接受了化疗，110例（20%）在急性护理病房死亡。总体上，395例患者（71%）至少符合一项积极癌症治疗的标准。当PCT转诊发生在死亡前>1个月时，积极的癌症治疗明显较少见（p<0.0001）。
尽管有国际推荐意见鼓励综合姑息治疗，但仍需要更多研究来了解晚期转诊的原因。
本研究获得了格勒诺布尔教学医院伦理委员会以及法国国家信息与自由委员会（CNIL；French national commission for data privacy; Commission Nationale de l'Informatique et des Libertés）的批准，批准号为1987785 v 0。由于伦理和法律限制，数据仅可按需提供。
