27054Caisse Nationale d'Assurance Maladie (CNAM), Paris, France.
Hôpital Henri Mondor, APHP, Créteil, France.
Cancer Control. 2020 Jan-Dec;27(1):1073274820977175. doi: 10.1177/1073274820977175.
Health care utilization of women with breast cancer (BC) during the last year of life, together with the causes and place of death and associated expenditure have been poorly described. Women treated for BC (2014-2015) with BC as a cause of death in 2015 and covered by the national health insurance general scheme (77% of the population) were identified in the French health data system (n = 6,696, mean age: 68.7 years, SD ± 15). Almost 70% died in short-stay hospitals (SSH), 4% in hospital-at-home (HaH), 9% in Rehab, 5% in skilled nursing homes (SNH) and 12% at home. One-third presented cardiovascular comorbidity. During the last year, 90% were hospitalized at least once in SSH, 25% in Rehab, 13% in HaH and 71% received hospital palliative care (HPC), but only 5% prior to their end-of-life stay. During the last month, 85% of women were admitted at least once to a SSH, 42% via the emergency department, 10% to an ICU, 24% received inpatient chemotherapy and 18% received outpatient chemotherapy. Among the 83% of women who died in hospital, independent factors for HPC use were cardiovascular comorbidity (adjusted odds ratio, aOR: 0.83; 95%CI: 0.72-0.95) and, in the 30 days before death, at least one SNH stay (aOR: 0.52; 95%CI: 0.36-0.76), ICU stay (aOR: 0.36; 95%CI: 0.30-0.43), inpatient chemotherapy (aOR: 0.55; 95%CI: 0.48-0.63), outpatient chemotherapy (aOR: 0.60; 95%CI: 0.51-0.70), death in Rehab (aOR: 1.4; 95%CI: 1.05-1.86) or HAH (aOR: 4.5; 95%CI: 2.47-8.1) vs SSH. Overall mean expenditure reimbursed per woman was €38,734 and €42,209 for those with PC. Women with inpatient or outpatient chemotherapy during the last month had lower rates of HPC, suggesting declining use of HPC before death. This study also indicates SSH-centered management with increased use of HPC in HaH and Rehab units and decreased access to HPC in SNH.
在生命的最后一年，患有乳腺癌（BC）的女性的医疗保健利用情况，以及死亡原因、地点和相关支出都描述得很差。在法国健康数据系统中，识别出了在 2015 年因 BC 而死亡且接受 BC 治疗（2014-2015 年）的女性（n=6696，平均年龄：68.7 岁，SD ± 15），这些女性被纳入国民健康保险综合计划（占人口的 77%）。近 70%的患者在短期住院医院（SSH）去世，4%在医院居家（HaH），9%在康复医院（Rehab），5%在熟练护理院（SNH），12%在家中去世。三分之一的患者患有心血管合并症。在生命的最后一年，90%的患者至少在 SSH 住院一次，25%的患者在 Rehab 住院，13%的患者在 HaH 住院，71%的患者接受医院姑息治疗（HPC），但只有 5%的患者在临终前接受了 HPC。在最后一个月，85%的女性至少在 SSH 住院一次，42%是通过急诊室，10%在 ICU，24%接受住院化疗，18%接受门诊化疗。在 83%死于医院的女性中，使用 HPC 的独立因素是心血管合并症（调整后的优势比，aOR：0.83；95%CI：0.72-0.95），以及在死亡前 30 天，至少有一次 SNH 住院（aOR：0.52；95%CI：0.36-0.76）、ICU 住院（aOR：0.36；95%CI：0.30-0.43）、住院化疗（aOR：0.55；95%CI：0.48-0.63）、门诊化疗（aOR：0.60；95%CI：0.51-0.70）、在 Rehab 或 HaH 中死亡（aOR：1.4；95%CI：1.05-1.86）。每个女性的平均总支出为 38734 欧元，接受 PC 治疗的女性为 42209 欧元。在最后一个月接受住院或门诊化疗的女性，HPC 的使用率较低，这表明在死亡前 HPC 的使用率下降。这项研究还表明 SSH 中心化管理，HaH 和 Rehab 单位中 HPC 的使用增加，SNH 中 HPC 的获得减少。
