Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.
Institute of Global Health Innovation, Department of Surgery and Cancer, Imperial College London, London, UK.
Br J Cancer. 2022 Sep;127(4):712-719. doi: 10.1038/s41416-022-01828-0. Epub 2022 May 11.
Delivering high-quality palliative and end-of-life care for cancer patients poses major challenges for health services. We examine the intensity of cancer care in England in the last year of life.
We included cancer decedents aged 65+ who died between January 1, 2010 and December 31, 2017. We analysed healthcare utilisation and costs in the last 12 months of life including hospital-based activities and primary care.
Healthcare utilisation and costs increased sharply in the last month of life. Hospital costs were the largest cost elements and decreased with age (0.78, 95% CI: 0.73-0.72, p < 0.005 for age group 90+ compared to age 65-69 and increased substantially with comorbidity burden (2.2, 95% CI: 2.09-2.26, p < 0.005 for those with 7+ comorbidities compared to those with 1-3 comorbidities). The costs were highest for haematological cancers (1.45, 95% CI: 1.38-1.52, p < 0.005) and those living in the London region (1.10, 95% CI: 1.02-1.19, p < 0.005).
Healthcare in the last year of life for advanced cancer patients is costly and offers unclear value to patients and the healthcare system. Further research is needed to understand distinct cancer populations' pathways and experiences before recommendations can be made about the most appropriate models of care.
为癌症患者提供高质量的姑息治疗和临终关怀对医疗服务提出了重大挑战。我们研究了英格兰在癌症患者生命的最后一年中提供的癌症护理强度。
我们纳入了年龄在 65 岁以上、2010 年 1 月 1 日至 2017 年 12 月 31 日期间去世的癌症患者。我们分析了生命最后 12 个月的医疗保健利用情况和费用，包括医院内活动和初级保健。
生命最后一个月的医疗保健利用和费用急剧增加。医院费用是最大的成本要素，且随年龄增长而降低（90 岁以上年龄组与 65-69 岁年龄组相比，0.78，95%CI：0.73-0.72，p<0.005），且随合并症负担的增加而大幅增加（2.2，95%CI：2.09-2.26，p<0.005，与有 1-3 种合并症的患者相比，有 7 种以上合并症的患者）。血液癌患者的费用最高（1.45，95%CI：1.38-1.52，p<0.005），居住在伦敦地区的患者费用最高（1.10，95%CI：1.02-1.19，p<0.005）。
晚期癌症患者生命最后一年的医疗保健费用高昂，对患者和医疗保健系统的价值不明确。需要进一步研究，以了解不同癌症患者群体的途径和体验，然后才能就最合适的护理模式提出建议。
