Departments of Internal Medicine.
Division of Hematology and Oncology.
Am J Clin Oncol. 2021 May 1;44(5):181-186. doi: 10.1097/COC.0000000000000802.
Most patients with pancreatic cancer have high symptom burden and poor outcomes. Palliative care (PC) can improve the quality of care through expert symptom management, although the optimal timing of PC referral is still poorly understood. We aimed to assess the association of early PC on health care utilization and charges of care for pancreatic cancer patients.
We selected patients with pancreatic cancer diagnosed between 2000 and 2009 who received at least 1 PC encounter using the Surveillance, Epidemiology, and End Results (SEER)-Medicare. Patients who had unknown follow-up were excluded. We defined "early PC" if the patients received PC within 30 days of diagnosis.
A total of 3166 patients had a PC encounter; 28% had an early PC. Patients receiving early PC were more likely to be female and have older age compared with patients receiving late PC (P<0.001). Patients receiving early PC had fewer emergency department (ED) visits (2.6 vs. 3.0 visits, P=0.004) and lower total charges of ED care ($3158 vs. $3981, P<0.001) compared with patients receiving late PC. Patients receiving early PC also had lower intensive care unit admissions (0.82 vs. 0.98 visits, P=0.006) and total charges of intensive care unit care ($14,466 vs. $18,687, P=0.01). On multivariable analysis, patients receiving early PC were significantly associated with fewer ED visits (P=0.007) and lower charges of ED care (P=0.018) for all patients.
Early PC referrals were associated with lower ED visits and ED-related charges. Our findings support oncology society guideline recommendations for early PC in patients with advanced malignancies such as pancreatic cancer.
大多数胰腺癌患者的症状负担较重，预后较差。姑息治疗（PC）可以通过专家症状管理来改善护理质量，尽管 PC 转介的最佳时机仍不清楚。我们旨在评估早期 PC 对胰腺癌患者的医疗保健利用和护理费用的影响。
我们选择了 2000 年至 2009 年间诊断为胰腺癌并至少接受过一次 PC 治疗的患者，这些患者来自监测、流行病学和最终结果（SEER）-医疗保险数据库。我们排除了未知随访的患者。如果患者在诊断后 30 天内接受了 PC，我们将其定义为“早期 PC”。
共有 3166 名患者接受了 PC 治疗；28%的患者接受了早期 PC。与接受晚期 PC 的患者相比，接受早期 PC 的患者更有可能是女性，年龄更大（P<0.001）。与接受晚期 PC 的患者相比，接受早期 PC 的患者急诊就诊次数更少（2.6 次 vs. 3.0 次，P=0.004），急诊护理总费用更低（3158 美元 vs. 3981 美元，P<0.001）。接受早期 PC 的患者 ICU 入院次数也更少（0.82 次 vs. 0.98 次，P=0.006），ICU 护理总费用更低（14466 美元 vs. 18687 美元，P=0.01）。多变量分析显示，接受早期 PC 的患者在所有患者中急诊就诊次数显著减少（P=0.007），急诊护理费用也显著降低（P=0.018）。
早期 PC 转介与急诊就诊次数减少和与急诊相关的费用降低有关。我们的研究结果支持肿瘤学会指南关于在胰腺癌等晚期恶性肿瘤患者中早期 PC 的建议。
