Sridharan Krita, Paul Eldho, Stirling Robert G, Li Chi
Department of Palliative Care, Alfred Health, Melbourne, Victoria, Australia.
Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Intern Med J. 2021 Sep;51(9):1450-1456. doi: 10.1111/imj.15215.
Multidisciplinary meeting (MDM) discussion and early palliative care are recommended in lung cancer management. The literature is unclear whether MDM discussion leads to early palliative care and improved end-of-life care.
To evaluate impacts of discussion at an Australian lung MDM on palliative care referral, and MDM and early palliative care on aggressive end-of-life care.
A retrospective, cross-sectional study was conducted of 352 patients diagnosed with primary lung cancer from 2017 to 2019 at the Alfred Hospital, Melbourne. The primary question was whether MDM discussion influenced palliative care referrals. Secondary questions were whether MDM discussion and early palliative care reduced aggressive treatment (chemotherapy, hospitalisation, emergency department visits, intensive care admission and in-hospital death) during the last 30 days of life. Multivariable logistic regression was used to determine independent association between MDM discussion and palliative care referral.
MDM discussion did not independently impact palliative care referral. There was reduced likelihood of MDM presentation in patients with metastatic disease (P < 0.0001) and poorer performance status (P = 0.025), and higher likelihood of palliative care referral in these patients (both P < 0.001). MDM discussion reduced end-of-life intensive care unit (ICU) admission in patients with metastatic disease (P = 0.04). A palliative care referral-to-death interval of ≥30 days was associated with reduced hospitalisation at the end of life (P < 0.0001) and hospital deaths (P = 0.001).
Discussion at lung MDM did not increase palliative care referral, but did reduce ICU admission among metastatic patients at the end of life. Longer palliative care referral-to-death interval was associated with reduced aggressive end-of-life care. Further research is needed in these areas.
肺癌管理中推荐进行多学科会诊（MDM）讨论及早期姑息治疗。目前尚不清楚MDM讨论是否能带来早期姑息治疗并改善临终关怀。
评估澳大利亚肺癌MDM讨论对姑息治疗转诊的影响，以及MDM和早期姑息治疗对积极临终关怀的影响。
对2017年至2019年在墨尔本阿尔弗雷德医院确诊为原发性肺癌的352例患者进行回顾性横断面研究。主要问题是MDM讨论是否影响姑息治疗转诊。次要问题是MDM讨论和早期姑息治疗是否减少了生命最后30天内的积极治疗（化疗、住院、急诊就诊、重症监护病房入院和院内死亡）。采用多变量逻辑回归确定MDM讨论与姑息治疗转诊之间的独立关联。
MDM讨论并未独立影响姑息治疗转诊。转移性疾病患者（P < 0.0001）和功能状态较差患者（P = 0.025）进行MDM陈述的可能性降低，而这些患者进行姑息治疗转诊的可能性更高（均P < 0.001）。MDM讨论减少了转移性疾病患者临终时重症监护病房（ICU）的入院率（P = 0.04）。姑息治疗转诊至死亡间隔≥30天与临终时住院率降低（P < 0.0001）和院内死亡减少（P = 0.001）相关。
肺癌MDM讨论并未增加姑息治疗转诊，但确实减少了转移性患者临终时的ICU入院率。较长的姑息治疗转诊至死亡间隔与减少积极的临终关怀相关。这些领域需要进一步研究。
Zotero 插件