Rodriguez Robin R, Babar Laila, Lo Herman, Ashraf Obaid, Monga Dulabh, Finley Gene, Doverspike Lisa, Blackledge Amber, Sethi Ashish, Raj Moses S
Medical Oncology, Allegheny Health Network, Pittsburgh, USA.
Medical Oncology, The University of Iowa Hospitals and Clinics, Iowa City, USA.
Cureus. 2021 Jan 9;13(1):e12589. doi: 10.7759/cureus.12589.
Purpose This study was conducted to determine factors that influence palliative care (PC) consultation in patients receiving cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC). Patient and methods We queried our Electronic Medical Record EPIC for a list of patients who underwent cytoreductive surgery with HIPEC or hyperthermic intrathoracic chemotherapy (HITEC) in the hospital from April 2016-April 2019. Data was manually extracted and patients who did not meet our criteria were excluded. Patients were divided on the basis of palliative care consults and differences between the groups were analyzed. Odds ratios (OR) with p-value of 0.05 and confidence interval of (CI) 95% were calculated. Results We identified 55 patients of whom 34 met our inclusion criteria: 11 males and 23 females with an average age of 56 years at the time of diagnosis. Eight patients (23%) had PC, with six having commercial insurance, seven married, and six with more than one comorbid medical issue. Comorbidities >1 (OR: 0.12; CI: 0.02-0.76; p: 0.02) and age >40 (OR: 0.015; CI: 0.0007-0.3029; P: 0.006) were associated with a higher likelihood of PC. Gender, insurance type, and marital status did not have a significant association with PC. Mean age between PC consulted patients versus non-PC consulted patients was 58.5 vs. 55.9 and median age between the two groups was 60.5 vs. 60 which also showed a trend towards higher rates of PC in the older population. Conclusion Approximately one quarter of patients who underwent CRS with HIPEC had a concurrent PC consult. Though this is better than the national average of 11-16%, it continues to be a very small number. Efforts must be made to engage PC early in the course of treatment and recognize it as an integral part of cancer care. PC is not only an end-of-life service, in fact, studies have shown that early consultations lead to higher patient satisfaction, improved quality of life, and better communication.
目的 本研究旨在确定影响接受减瘤手术（CRS）联合热灌注化疗（HIPEC）患者姑息治疗（PC）会诊的因素。
患者与方法 我们在电子病历系统EPIC中查询了2016年4月至2019年4月期间在我院接受CRS联合HIPEC或热胸内化疗（HITEC）患者的名单。手动提取数据，排除不符合标准的患者。根据姑息治疗会诊情况对患者进行分组，并分析组间差异。计算比值比（OR）、p值为0.05以及95%置信区间（CI）。
结果 我们确定了55例患者，其中34例符合纳入标准：11例男性和23例女性，诊断时平均年龄为56岁。8例患者（23%）接受了PC会诊，其中6例有商业保险，7例已婚，6例有不止一种合并症。合并症>1（OR：0.12；CI：0.02 - 0.76；p：0.02）和年龄>40岁（OR：0.015；CI：0.0007 - 0.3029；P：0.006）与接受PC会诊的可能性较高相关。性别、保险类型和婚姻状况与PC会诊无显著关联。接受PC会诊患者与未接受PC会诊患者的平均年龄分别为58.5岁和55.9岁，两组的年龄中位数分别为60.5岁和60岁，这也显示出老年人群中接受PC会诊的比例有升高趋势。
结论 接受CRS联合HIPEC的患者中约四分之一同时接受了PC会诊。虽然这高于11 - 16%的全国平均水平，但仍然是一个非常小的比例。必须努力在治疗过程早期引入PC会诊，并将其视为癌症治疗的一个组成部分。PC不仅是临终服务，事实上，研究表明早期会诊可提高患者满意度、改善生活质量并促进更好的沟通。
