Department of Radiation Oncology, Duke University School of Medicine, 20 Duke Medicine Cir, Durham, NC, 27710, USA.
Department of Interventional Radiology, Weill Cornell Medical Center, New York-Presbyterian Hospital, New York, NY, USA.
Support Care Cancer. 2022 Aug;30(8):6795-6805. doi: 10.1007/s00520-022-07120-4. Epub 2022 May 9.
Patients with primary or metastatic brain tumors often require intensive end-of-life care, for which place of death may serve as a quality metric. Death at home or hospice is considered a more "ideal" location. Comprehensive information on place of death of people with brain tumors is lacking.
Using CDC Wonder Database data, those who died in the USA from a solid cancer from 2003 to 2016 were included and place of death for those with primary brain, brain metastases, and solid non-brain tumors were compared. Multivariate logistic regression tested for disparities in place of death.
By 2016, 51.1% of patients with primary brain tumors and 45.2% with brain metastases died at home. 15.9% of patients with primary brain tumors and 23.6% with brain metastases died in the hospital. Black patients were least likely to die at home or hospice. For patients with primary brain tumors, being married (OR = 2.25 (95%CI 2.16-2.34), p < 0.01) and having an advanced degree (OR = 1.204 (95%CI 1.15-1.26), p < 0.01) increased odds of home/hospice death; older age (OR = 0.50 (95%CI 0.46-0.54), p < 0.01) decreased odds for home/hospice death. For patients with brain metastases, being married (OR = 2.19 (95%CI 2.11-2.26), p < 0.01) increased odds of home/hospice death and male sex (OR = 0.87 (095%CI .85-0.89), p < 0.01) and older age (OR = 0.59 (95%CI 0.47-0.75), p < 0.01) decreased odds of home/hospice death.
Disparities exist in place of death in the brain tumor population. Focused interventions are indicated to increase the utilization of hospice in those with metastatic cancer, under-represented minority groups, and the elderly population.
原发性或转移性脑肿瘤患者通常需要接受临终关怀，而死亡地点可以作为衡量临终关怀质量的标准。在家中或临终关怀机构死亡被认为是更“理想”的地点。目前缺乏关于脑肿瘤患者死亡地点的综合信息。
利用美国疾病控制与预防中心（CDC）Wonder 数据库的数据，纳入 2003 年至 2016 年期间在美国死于实体癌的患者，并比较了原发性脑肿瘤、脑转移瘤和非脑实体瘤患者的死亡地点。采用多变量逻辑回归检验死亡地点的差异。
到 2016 年，51.1%的原发性脑肿瘤患者和 45.2%的脑转移瘤患者在家中死亡。15.9%的原发性脑肿瘤患者和 23.6%的脑转移瘤患者在医院死亡。黑人患者在家中或临终关怀机构死亡的可能性最低。对于原发性脑肿瘤患者，已婚（OR=2.25（95%CI 2.16-2.34），p<0.01）和拥有高等学历（OR=1.204（95%CI 1.15-1.26），p<0.01）会增加在家/临终关怀机构死亡的几率；年龄较大（OR=0.50（95%CI 0.46-0.54），p<0.01）会降低在家/临终关怀机构死亡的几率。对于脑转移瘤患者，已婚（OR=2.19（95%CI 2.11-2.26），p<0.01）会增加在家/临终关怀机构死亡的几率，而男性（OR=0.87（95%CI 0.85-0.89），p<0.01）和年龄较大（OR=0.59（95%CI 0.47-0.75），p<0.01）会降低在家/临终关怀机构死亡的几率。
脑肿瘤患者的死亡地点存在差异。需要有针对性地干预，以增加转移性癌症、代表性不足的少数族裔和老年人群体对临终关怀的利用。
