National Cancer Registration and Analysis Service, NHS Digital, Leeds, UK.
Imperial College NHS Trust, London, UK.
Eur J Cancer Care (Engl). 2022 Jul;31(4):e13598. doi: 10.1111/ecc.13598. Epub 2022 May 27.
Patients with incurable breast cancer may be treated with chemotherapy to improve cancer-related symptoms, quality of life and survival. We examined the association between use of palliative chemotherapy towards the end of life in breast cancer patients and outcomes including unplanned hospital admission and place of death.
A total of 10,966 women, treated with palliative chemotherapy for breast cancer (diagnosed 1995-2017 in England) within the 2 years prior to death (death between 2014 and 2017), were analysed. Logistic regression (outcome = emergency hospital admission in last 90 days of life yes/no; outcome = place of death hospital/other) was performed, adjusting for line of palliative chemotherapy in the last 90 days of life and patient demographics.
The odds of hospital admission reduced with increasing line of chemotherapy received (1st line odds ratio [OR] = 2.7, 2nd line OR = 2.1, 3rd line OR = 1.9, 4th+ line OR = 1.7; baseline chemotherapy) in last 90 days of life. A similar relationship was observed for hospital death (1st line OR = 2.4, 2nd line OR = 2.1, 3rd line OR = 1.7, 4th+ line OR = 1.5).
This study finds palliative chemotherapy towards the end of life to be associated with increased odds of unplanned hospital admissions and hospital death. These findings can be used to inform discussions between patients and healthcare professionals towards the end of life.
对于无法治愈的乳腺癌患者，可采用化疗来改善癌症相关症状、生活质量和生存状况。本研究旨在探究在乳腺癌患者生命末期使用姑息性化疗与未计划入院和死亡地点等结局之间的相关性。
共纳入 10966 名在死亡前 2 年内（2014 年至 2017 年期间死亡）接受过姑息性化疗（1995 年至 2017 年期间在英国诊断）的女性患者。采用逻辑回归（结局=生命最后 90 天内是否紧急入院；结局=死亡地点为医院/其他）进行分析，调整生命最后 90 天内姑息性化疗的方案以及患者的人口统计学特征。
随着接受化疗方案数的增加，入院的可能性降低（生命最后 90 天内接受一线化疗的优势比[OR]为 2.7，接受二线化疗的 OR 为 2.1，接受三线化疗的 OR 为 1.9，接受四线及以上化疗的 OR 为 1.7；以基线化疗为对照）。对于医院死亡，也观察到类似的关系（生命最后 90 天内接受一线化疗的 OR 为 2.4，接受二线化疗的 OR 为 2.1，接受三线化疗的 OR 为 1.7，接受四线及以上化疗的 OR 为 1.5）。
本研究发现，生命末期的姑息性化疗与未计划入院和医院死亡的可能性增加相关。这些发现可用于在生命末期与患者和医疗保健专业人员进行讨论。
