Graduate School of Medicine, Osaka University, Osaka, Japan.
Department of Integrated Health Sciences, Graduate School of Medicine, Nagoya University, Aichi, Japan.
Cancer Med. 2021 Dec;10(24):8799-8807. doi: 10.1002/cam4.4382. Epub 2021 Nov 29.
The aim of this study was to examine the following by using a non-wearable monitor: (ⅰ) the trajectory of vital signs (VS) in the last 2 weeks of life among cancer patients, and (ⅱ) the difference in change over time of VS between cancer patients with and without opioid use.
We conducted a longitudinal study involving cancer patients in a palliative care unit (PCU) from April 2018 to October 2019. VS were collected continuously using a non-wearable monitor, and we calculated the means of respiratory rate (RR) and heart rate (HR) per hour, and counts of apnea per hour as outcome variables. Explanatory variables were time (subtracting time of death from measurement time of VS, divided by 36) and opioid use. Mean difference (MD) of time represented the slope per hour of VS values. First, we analyzed the associations between VS per hour and time using a linear mixed model (LMM) with random intercepts and slope over time. Second, we analyzed the associations between VS and interaction term between time and opioid use.
We analyzed 26 cancer patients. RR (MD: 0.27 beats/min [95% CI: 0.27-0.28]), HR (MD: 1.51 beats/min [95% CI: 1.50-1.52]), and apnea (MD: 0.71 count/hour [95% CI: 0.70-0.72]) significantly increased hourly. In addition, RR was significantly associated with interaction term (MD: -1.59 beats/min [95% CI: -3.11 to -0.07]), which indicates that there is a difference in the slope of RR between opioid users and non-users.
We have successfully described the trajectory of VS in high-resolution under conditions of a natural end of life in PCU.
本研究旨在使用非穿戴式监测仪来检测：（ⅰ）癌症患者生命终末期的生命体征（VS）轨迹；（ⅱ）癌症患者中 VS 随时间变化的差异，这些患者有无阿片类药物使用。
我们进行了一项纵向研究，纳入了 2018 年 4 月至 2019 年 10 月在姑息治疗病房（PCU）的癌症患者。使用非穿戴式监测仪连续采集 VS，计算每小时的呼吸频率（RR）和心率（HR）均值以及每小时的呼吸暂停次数。解释变量为时间（从 VS 测量时间减去死亡时间，除以 36）和阿片类药物使用。时间的均值差（MD）代表 VS 值每小时的斜率。首先，我们使用具有随机截距和随时间变化斜率的线性混合模型（LMM）分析了每小时 VS 与时间之间的关系。其次，我们分析了 VS 与时间和阿片类药物使用之间交互项的关系。
我们分析了 26 例癌症患者。RR（MD：0.27 次/分钟[95%CI：0.27-0.28]）、HR（MD：1.51 次/分钟[95%CI：1.50-1.52]）和呼吸暂停（MD：0.71 次/小时[95%CI：0.70-0.72]）每小时显著增加。此外，RR 与交互项显著相关（MD：-1.59 次/分钟[95%CI：-3.11 至-0.07]），这表明阿片类药物使用者和非使用者 RR 的斜率存在差异。
我们成功地描述了 PCU 中自然生命末期条件下 VS 的轨迹。
