Abdelaal Mohamed, Mosher Pamela J, Gupta Abha, Hannon Breffni, Cameron Christine, Berman Malka, Moineddin Rahim, Avery Jonathan, Mitchell Laura, Li Madeline, Zimmermann Camilla, Al-Awamer Ahmed
Department of Supportive Care, University Health Network, Toronto, ON M5G 2C4, Canada.
Princess Margaret Cancer Centre, University Health Network, 620 University Ave., Toronto, ON M5G 2C1, Canada.
Cancers (Basel). 2021 Feb 12;13(4):770. doi: 10.3390/cancers13040770.
Clinical guidelines aimed at cancer care for adolescents and young adults (AYAs) encourage early integration of palliative care, yet there are scarce data to support these recommendations. We conducted a retrospective chart review of AYA patients, aged 15 to 39 years, who were referred to the Integrated AYA Palliative Care and Psychiatry Clinic (IAPCPC) at the Princess Margaret Cancer Centre between May 2017 and November 2019 ( = 69). Demographic data, symptom prevalence, change in symptom scores between baseline consultation and first follow-up, and intensity of end-of-life care were collected from the patients' medical charts, analyzed, and reported. Of the 69 patients, 59% were female, and sarcoma was the most common cancer. A majority of patients had at least one symptom scored as moderate to severe; tiredness, pain, and sleep problems were the highest scored symptoms. More than one-third used medical cannabis to manage their symptoms. Symptom scores improved in 61% after the first clinic visit. Out of the 69 patients, 50 (72.5%) had died by October 2020, with a median time between the initial clinic referral and death of 5 months (range 1-32). Three patients (6%) received chemotherapy, and eight (16%) were admitted to an intensive care unit during the last month of life. In conclusion, AYAs with advanced cancer have a high burden of palliative and psychosocial symptoms. Creating a specialized AYA palliative care clinic integrated with psychiatry showed promising results in improving symptom scores and end-of-life planning.
针对青少年和青年成人（AYA）癌症护理的临床指南鼓励早期纳入姑息治疗，但支持这些建议的数据却很少。我们对2017年5月至2019年11月期间转诊至玛格丽特公主癌症中心综合AYA姑息治疗与精神病诊所（IAPCPC）的15至39岁AYA患者进行了回顾性病历审查（n = 69）。从患者病历中收集、分析并报告了人口统计学数据、症状患病率、基线咨询与首次随访之间症状评分的变化以及临终护理强度。69名患者中，59%为女性，肉瘤是最常见的癌症。大多数患者至少有一种症状被评为中度至重度；疲劳、疼痛和睡眠问题是评分最高的症状。超过三分之一的患者使用医用大麻来控制症状。首次就诊后，61%的患者症状评分有所改善。在69名患者中，截至2020年10月，有50名（72.5%）死亡，从首次诊所转诊到死亡的中位时间为5个月（范围1 - 32个月）。3名患者（6%）接受了化疗，8名（16%）在生命的最后一个月入住了重症监护病房。总之，患有晚期癌症的AYA患者有很高的姑息和心理社会症状负担。创建一个与精神病学相结合的专门的AYA姑息治疗诊所，在改善症状评分和临终规划方面显示出了有希望的结果。
