George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Avenue, NW, DC Level, Washington, DC, 20037, USA.
Support Care Cancer. 2021 Nov;29(11):6625-6632. doi: 10.1007/s00520-021-06255-0. Epub 2021 May 4.
Primary brain malignancies (PBMs) pose significant morbidity and poor prognosis. Despite NCCN recommendations that palliative care should be integrated into general oncologic care plans, it has been historically underused in patients with PBM. We sought to examine trends and factors associated with inpatient palliative care use in patients with PBM.
Data from the 2007-2016 National (Nationwide) Inpatient Sample was analyzed for descriptive statistics and trends. Multivariable logistic regression was used to identify factors associated with inpatient palliative care in patients with PBMs.
Of the 510,238 observed hospitalizations of adults with PBM in a 10-year period, 37,365 (7.3%) had an associated inpatient palliative care consult. Rates of inpatient palliative care have increased significantly over the 10-year period, from 2.3 in 2007 to 11.9% in 2011. Patients receiving inpatient palliative care were less likely to receive inpatient oncologic treatment such as brain surgery, chemotherapy, or radiation compared to those without palliative care (14.6% with palliative care vs. 42.4% without, p < 0.001). They were more likely to receive life-sustaining treatments such as intubation, mechanical ventilation, tracheostomy, nutritional support, hemodialysis, or CPR (21.0% with palliative care vs. 10.4% without, p < 0.001). Palliative care was associated with decreased cost of admission ($18,602 with palliative care vs. $20,077 without). In a multiple variable logistic regression, age, non-elective admission, comorbidities, history of chemotherapy and radiation, and mechanical ventilation were associated with significantly increased odds of receiving palliative care.
Inpatient palliative care utilization for patients hospitalized with PBM significantly increased between 2007 and 2016, though the service is still underutilized in the context of the severe symptoms and poor prognosis associated with PBM.
原发性脑恶性肿瘤（PBM）会导致严重的发病率和预后不良。尽管 NCCN 建议将姑息治疗纳入一般肿瘤治疗计划，但在 PBM 患者中历史上使用不足。我们旨在研究 PBM 患者住院期间使用姑息治疗的趋势和相关因素。
对 2007-2016 年全国（全国范围内）住院患者样本数据进行描述性统计和趋势分析。使用多变量逻辑回归来确定 PBM 患者住院期间接受姑息治疗的相关因素。
在 10 年期间，观察到 510238 名患有 PBM 的成年人住院，其中 37365 人（7.3%）接受了相关的住院姑息治疗咨询。在 10 年内，住院姑息治疗的比例显著增加，从 2007 年的 2.3%增加到 2011 年的 11.9%。与未接受姑息治疗的患者相比，接受住院姑息治疗的患者接受脑外科手术、化疗或放疗等住院肿瘤治疗的可能性较小（接受姑息治疗的患者为 14.6%，未接受姑息治疗的患者为 42.4%，p<0.001）。他们更有可能接受生命维持治疗，如插管、机械通气、气管造口术、营养支持、血液透析或心肺复苏术（接受姑息治疗的患者为 21.0%，未接受姑息治疗的患者为 10.4%，p<0.001）。姑息治疗与入院费用降低有关（接受姑息治疗的患者为 18602 美元，未接受姑息治疗的患者为 20077 美元）。在多变量逻辑回归中，年龄、非选择性入院、合并症、化疗和放疗史以及机械通气与接受姑息治疗的可能性显著增加相关。
2007 年至 2016 年期间，因 PBM 住院的患者接受姑息治疗的比例显著增加，但在 PBM 相关严重症状和预后不良的情况下，姑息治疗仍未得到充分利用。
