Johnson Alyson M, Wolf Steven, Xuan Mengdi, Samsa Greg, Kamal Arif, Fisher Deborah A
Division of Gastroenterology and Hepatology, Duke University School of Medicine, Durham, NC, USA.
Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA.
J Palliat Care. 2023 Apr;38(2):152-156. doi: 10.1177/08258597211001596. Epub 2021 Mar 18.
Pancreatic cancer has a poor 5-year survival and carries significant morbidity. Pain is a commonly studied symptom in pancreatic cancer; however, few studies examine the frequency of multiple patient-reported symptoms. Our aim is to ascertain patient-reported symptom burden at initial consultation with a palliative care provider and compare patient prognostic awareness to provider estimation of prognosis.
Data were extracted from the standardized Quality Data Collection Tool (QDACT). Adults with pancreatic cancer seen by a palliative care provider were included. Descriptive statistics were used to describe demographic features, symptom prevalence and burden, as well as assess patient prognosis awareness defined by congruence or incongruence with provider estimated prognosis.
285 patients were included in our analysis. The average age was 68 years (SD: 12.4), 87.2% were white, 50% male. The mean number of moderate/severe symptoms was 2.6 (SD: 2) out of 9 symptoms. Tiredness (66.7%), appetite (64.5%) and pain (46.2%) had the highest rates of moderate/severe symptom burden. Patients with a prognosis of 1-6 months had the lowest proportion of congruence with provider estimation (56.5%).
Our study suggests targets to improve patient-centered care of pancreatic cancer. Patients commonly have multiple symptoms that are moderate/severe at time of palliative care referral. While pain has been well-reported, tiredness and decreased appetite are more prevalent at initial visit. This emphasizes the importance of assessing multiple symptoms and working closely with palliative care for early referral. Overall, one third of patient prognosis estimates differed from the provider assessment of prognosis. Our data support the importance of early referral to palliative care to manage symptoms and better prepare patients for end-of-life care.
胰腺癌的5年生存率较低，且发病率较高。疼痛是胰腺癌中一项经常被研究的症状；然而，很少有研究考察多种患者报告症状的发生频率。我们的目的是确定患者在首次咨询姑息治疗提供者时报告的症状负担，并将患者对预后的认知与提供者对预后的估计进行比较。
数据从标准化的质量数据收集工具（QDACT）中提取。纳入由姑息治疗提供者诊治的成年胰腺癌患者。描述性统计用于描述人口统计学特征、症状患病率和负担，并评估根据与提供者估计预后的一致性或不一致性定义的患者预后认知。
285名患者纳入我们的分析。平均年龄为68岁（标准差：12.4），87.2%为白人，50%为男性。9种症状中，中度/重度症状的平均数量为2.6（标准差：2）。疲劳（66.7%）、食欲（64.5%）和疼痛（46.2%）的中度/重度症状负担发生率最高。预后为1至6个月的患者与提供者估计一致的比例最低（56.5%）。
我们的研究提出了改善以患者为中心的胰腺癌护理的目标。患者在转诊至姑息治疗时通常有多种中度/重度症状。虽然疼痛已有充分报道，但疲劳和食欲下降在初次就诊时更为普遍。这强调了评估多种症状以及与姑息治疗密切合作以便早期转诊的重要性。总体而言，三分之一的患者预后估计与提供者的预后评估不同。我们的数据支持早期转诊至姑息治疗以管理症状并让患者更好地为临终护理做准备的重要性。
