Division of Urology, Department of Surgery, Faculty of Medical Sciences, University of Fukui, Fukui.
Department of Urology, Ibe Hospital, Fukui.
Medicine (Baltimore). 2021 Apr 9;100(14):e25397. doi: 10.1097/MD.0000000000025397.
Decision-making to stop cancer treatment in patients with advanced cancer is stressful, and it significantly influences subsequent end-of-life palliative treatment. However, little is known about the extent to which the patient's self-decisions influenced the prognostic period. This study focused on the patient's self-decision and investigated the impact of the self-decision to stop cancer treatment on their post-cancer treatment survival period and place of death.We retrospectively analyzed 167 cases of advanced genitourinary cancer patients (kidney cancer: 42; bladder cancer: 68; prostate cancer: 57) treated at the University of Fukui Hospital (UFH), who later died because of cancer. Of these, 100 patients decided to stop cancer treatment by themselves (self-decision group), while the families of the remaining 67 patients (family's decision group) decided to stop treatment on their behalf because the patient's decision-making ability was already impaired. Differences in the post-cancer-treatment survival period and place of death between the 2 groups were examined. The association between place of death and survival period was also analyzed.The median survival period after terminating cancer treatment was approximately 6 times longer in the self-decision group (145.5 days in self-decision group vs 23.0 days in family's decision group, P < .001). Proportions for places of death were as follows: among the self-decision group, 42.0% of patients died at UFH, 45.0% at other medical institutions, and 13.0% at home; among the family's decision group, 62.7% died at UFH, 32.8% at other medical institutions, and 4.5% at home. The proportion of patients who died at UFH was significantly higher among the family's decision group (P = .011). The median survival period was significantly shorter for patients who died at UFH (UFH: 30.0 days; other institutions/home: 161.0 days; P < .001).Significantly longer post-cancer-treatment survival period and higher home death rate were observed among patients whose cancer treatment was terminated based on their self-decision. Our results provide clinical evidence, especially in terms of prognostic period and place of death that support the importance of discussing bad news, such as stopping cancer treatment with patients.
在晚期癌症患者中决定停止癌症治疗是有压力的，这会显著影响后续的临终姑息治疗。然而，人们对患者的自我决策在多大程度上影响预后期知之甚少。本研究侧重于患者的自我决策，并调查了停止癌症治疗的自我决策对癌症治疗后生存期间和死亡地点的影响。
我们回顾性分析了在福井大学医院（UFH）治疗的 167 例晚期泌尿生殖系统癌症患者（肾癌：42 例；膀胱癌：68 例；前列腺癌：57 例）的病例，这些患者最终因癌症死亡。其中，100 例患者自行决定停止癌症治疗（自我决策组），而其余 67 例患者（家庭决策组）的家属代表他们决定停止治疗，因为这些患者的决策能力已经受损。检查了两组患者在癌症治疗后生存期间和死亡地点的差异。还分析了死亡地点与生存期间的关联。
在自我决策组中，停止癌症治疗后，中位生存期间大约延长了 6 倍（自我决策组为 145.5 天，家庭决策组为 23.0 天，P <.001）。死亡地点的比例如下：在自我决策组中，42.0%的患者在 UFH 死亡，45.0%在其他医疗机构死亡，13.0%在家中死亡；在家庭决策组中，62.7%在 UFH 死亡，32.8%在其他医疗机构死亡，4.5%在家中死亡。家庭决策组中在 UFH 死亡的患者比例明显更高（P =.011）。在 UFH 死亡的患者的中位生存期间明显更短（UFH：30.0 天；其他机构/家：161.0 天；P <.001）。
在基于自我决策终止癌症治疗的患者中，观察到癌症治疗后生存期间明显延长，并且在家中死亡的比例更高。我们的研究结果提供了临床证据，特别是在预后期间和死亡地点方面，支持与患者讨论停止癌症治疗等坏消息的重要性。
