Pasquarella Anthony V, Islam Shahidul, Ramdhanny Angela, Gendy Mina, Pinto Priya, Braunstein Marc J
Department of Medicine, Division of Oncology-Hematology, NYU Long Island School of Medicine, NYU Perlmutter Cancer Center, Mineola, NY.
Department of Biostatistics, NYU Long Island School of Medicine, Mineola, NY.
JCO Oncol Pract. 2022 May;18(5):e688-e696. doi: 10.1200/OP.21.00502. Epub 2022 Jan 5.
Palliative care (PC) plays an established role in improving outcomes in patients with solid tumors, yet these services are underutilized in hematologic malignancies (HMs). We reviewed records of hospitalized patients with active HM to determine associations between PC consultation and length of stay, intensive care unit stay, 30-day readmission, and 6-month mortality compared with those who were not seen by PC.
We reviewed all oncology admissions at our institution between 2013 and 2019 and included patients with HM actively on treatment, stratified by those seen by PC to controls not seen by PC. Groups were compared using Wilcoxon rank-sum, chi-square, and Fisher's exact tests on the basis of the type and distribution of data. Multiple logistic regression models with stepwise variable selection methods were used to find predictors of outcomes.
Three thousand six hundred fifty-four admissions were reviewed, among which 370 unique patients with HM were included. Among these, 102 (28%) patients saw PC, whereas the remaining 268 were controls with similar comorbidities. When compared with controls, PC consultation was associated with a statistically significant reduction in 30-day readmissions (16% 27%; = .024), increased length of stay (11.5 6 days; < .001), increased intensive care unit admission (28% 9%; < .001), and increased 6-month mortality (67% 15%; < .001). These data were confirmed in multivariable models.
In this retrospective study, more than two thirds of patients with HM did not receive PC consultation despite having similar comorbidities, suggesting that inpatient PC consultation is underutilized in patients with HM, despite the potential for decreased readmission rates.
姑息治疗（PC）在改善实体瘤患者的预后方面已发挥既定作用，但这些服务在血液系统恶性肿瘤（HM）中未得到充分利用。我们回顾了住院的活动性HM患者的记录，以确定与未接受PC会诊的患者相比，PC会诊与住院时间、重症监护病房住院时间、30天再入院率和6个月死亡率之间的关联。
我们回顾了2013年至2019年间我院所有肿瘤住院患者，并纳入了正在接受积极治疗的HM患者，按是否接受PC会诊分为两组。根据数据的类型和分布，使用Wilcoxon秩和检验、卡方检验和Fisher精确检验对两组进行比较。采用逐步变量选择方法的多因素逻辑回归模型来寻找预后的预测因素。
共回顾了3654例住院病例，其中包括370例独特的HM患者。其中，102例（28%）患者接受了PC会诊，其余268例为具有相似合并症的对照组。与对照组相比，PC会诊与30天再入院率显著降低（16%对27%；P = 0.024）、住院时间延长（11.5天对6天；P < 0.001）、重症监护病房入院率增加（28%对9%；P < 0.001）以及6个月死亡率增加（67%对15%；P < 0.001）相关。这些数据在多变量模型中得到了证实。
在这项回顾性研究中，超过三分之二的HM患者尽管合并症相似，但未接受PC会诊，这表明住院患者的PC会诊在HM患者中未得到充分利用，尽管其有可能降低再入院率。
