Domschikowski Justus, Koch Karoline, Schmalz Claudia
Department of Radiation Oncology, University-Hospital Schleswig-Holstein, Kiel, Germany.
Department of Pathology, University Hospital Schleswig-Holstein, Kiel, Germany.
Front Oncol. 2021 Oct 21;11:763629. doi: 10.3389/fonc.2021.763629. eCollection 2021.
The accurate attribution of death in oncologic patients is a difficult task. The patient's death is often attributed to his or her underlying cancer and therefore judged as cancer-related. We hypothesized that even though our patient's cancers were either advanced or metastatic, not all patients had died simply because of their cancer.
A total of 105 patients were included in this retrospective analysis. Patient data were collected from digital and paper-based records. Cause of death was assessed from death certificate and compared to the medical autopsy reports. Discrepancies between premortem and postmortem diagnoses were classified as class I and II discrepancies.
Of 105 patients included, autopsy consent was obtained in 56 cases (53%). Among them, 32 of 56 were palliatively sedated, and 42/56 patients died cancer-related as confirmed by autopsy. The most common cause of death by autopsy report was multiorgan failure followed by a combination of tumor and infection, predominantly lung cancer with pneumonia. Here, 21/56 cases (37%) showed major missed diagnoses: seven cases showed class I, 10 class II, and both discrepancies. The most commonly missed diagnoses in both categories were infections, again mainly pneumonia.
Cancer was the leading cause of death in our study population. A quarter of the patients, however, did not die due to their advanced or metastatic cancers but of potentially curable causes. We therefore conclude that it is important to consider competing causes of death when treating palliative cancer patients. In a palliative setting, the treatment of a potentially curable complication should be discussed with the patients and their families in a shared decision-making process. From our experience, many patients will decline treatment or even further diagnostics when given the option of best supportive care.
准确判定肿瘤患者的死亡原因是一项艰巨的任务。患者的死亡通常归因于其潜在的癌症，因此被判定为与癌症相关。我们推测，尽管我们的患者所患癌症已处于晚期或发生转移，但并非所有患者都仅仅因癌症而死亡。
本回顾性分析共纳入105例患者。患者数据从电子和纸质记录中收集。根据死亡证明评估死亡原因，并与医学尸检报告进行比较。生前诊断与死后诊断之间的差异分为I类和II类差异。
在纳入的105例患者中，56例（53%）获得了尸检同意。其中，56例中有32例接受了姑息性镇静，尸检证实42/56例患者死于癌症相关原因。尸检报告显示，最常见的死亡原因是多器官功能衰竭，其次是肿瘤与感染合并，主要是肺癌合并肺炎。在此，21/56例（37%）显示存在重大漏诊：7例为I类，10例为II类，以及两类差异均有。两类中最常见的漏诊原因均为感染，同样主要是肺炎。
在我们的研究人群中，癌症是主要死因。然而，四分之一的患者并非死于晚期或转移性癌症，而是死于潜在可治愈的原因。因此，我们得出结论，在治疗姑息性癌症患者时，考虑其他可能的死亡原因很重要。在姑息治疗环境中，应在共同决策过程中与患者及其家属讨论对潜在可治愈并发症的治疗。根据我们的经验，当提供最佳支持性治疗选项时，许多患者会拒绝治疗甚至进一步的诊断。
