在挪威，影响癌症患者生命终末期使用抗癌药物治疗的因素有哪些？一项回顾性登记研究。

What are determinants of utilisation of pharmaceutical anticancer treatment during the last year of life in Norway? A retrospective registry study.

机构信息

Department of Health Management and Health Economics, University of Oslo, Oslo, Norway

Oslo Economics AS, Oslo, Norway.

出版信息

BMJ Open. 2021 Sep 27;11(9):e050564. doi: 10.1136/bmjopen-2021-050564.

DOI:10.1136/bmjopen-2021-050564

PMID:34580099

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8477316/

Abstract

OBJECTIVES

The objective of this study was to investigate the use of, and predictors for, pharmaceutical anticancer treatment (PACT) towards the end of a patient's life in a country with a public healthcare system.

DESIGN

Retrospective registry study.

SETTING

Secondary care in Norway.

PARTICIPANTS

All Norwegian patients with cancer (International Classification of Diseases tenth revision (ICD-10) codes C00-99, D00-09, D37-48) in contact with a somatic hospital in Norway between 2009 and 2017 (N=420 655). Analyses were performed on a subsample of decedents with follow-back time of more than 1 year (2013-2017, N=52 496).

INTERVENTIONS

N/A.

PRIMARY AND SECONDARY OUTCOME MEASURES

Proportion of patients receiving PACT during the last year and month of life. We calculated CIs with block bootstrapping, while predictors of PACT were estimated with logistic regression.

RESULTS

24.0% (95% CI 23.4% to 24.6%) of the patients received PACT during the last year of life and 3.2% (95% CI 3.0% to 3.5%) during their final month. The proportion during the last month was highest for multiple myeloma (12.7%) and breast cancer (6.5%) and lowest for urinary tract (1.1%) and prostate and kidney cancer (1.4%). Patients living in northern (OR 0.80, 95% CI 0.68 to 0.94) and western (OR 0.85, 95% CI 0.75 to 0.96) Norway had lower odds of PACT during the last month, while patients with myeloma (OR 3.0, 95% CI 2.5 to 3.7) and breast (OR 1.4, 95% CI 1.1 to 1.6) had higher odds. Kidney cancer (OR 0.25, 95% CI 0.2. to 0.4), urinary tract (OR 0.38, 95% CI 0.3 to 0.5) and prostate cancer (OR 0.4, 95% CI 0.3 to 0.5) were associated with lower probability of receiving PACT within the last month.

CONCLUSIONS

The proportion of patients receiving PACT in Norway is lower than in several other industrialised countries. Age, type of cancer and area of living are significant determinants of variation in PACT.

摘要

目的

本研究旨在调查在一个拥有公共医疗体系的国家，患者生命末期使用抗癌药物治疗（PACT）的情况及其影响因素。

设计

回顾性注册研究。

地点

挪威的二级保健机构。

参与者

2009 年至 2017 年间与挪威一家综合医院有过接触的所有患有癌症的挪威患者（国际疾病分类第十版（ICD-10）编码 C00-99、D00-09、D37-48）（N=420655）。对随访时间超过 1 年的死亡患者亚组（2013-2017 年，N=52496）进行了分析。

干预措施

无。

主要和次要结局测量

患者在生命最后一年和最后一个月接受 PACT 的比例。我们使用块 bootstrapping 计算置信区间，同时使用逻辑回归估计 PACT 的预测因素。

结果

24.0%（95%CI 23.4%至 24.6%）的患者在生命的最后一年接受了 PACT，3.2%（95%CI 3.0%至 3.5%）在最后一个月接受了 PACT。多发性骨髓瘤（12.7%）和乳腺癌（6.5%）患者最后一个月的比例最高，而尿路上皮癌（1.1%）和前列腺癌和肾癌（1.4%）患者的比例最低。居住在挪威北部（OR 0.80，95%CI 0.68 至 0.94）和西部（OR 0.85，95%CI 0.75 至 0.96）的患者最后一个月接受 PACT 的可能性较低，而多发性骨髓瘤（OR 3.0，95%CI 2.5 至 3.7）和乳腺癌（OR 1.4，95%CI 1.1 至 1.6）患者的可能性较高。肾癌（OR 0.25，95%CI 0.2. 至 0.4）、尿路上皮癌（OR 0.38，95%CI 0.3 至 0.5）和前列腺癌（OR 0.4，95%CI 0.3 至 0.5）患者最后一个月接受 PACT 的可能性较低。