Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Breast Center, Department of Surgery, Capio St Gorans Sjukhus, St Görans plan 1, 112 19, Stockholm, Sweden.
Support Care Cancer. 2022 Sep;30(9):7721-7730. doi: 10.1007/s00520-022-07150-y. Epub 2022 Jun 14.
There are inequalities in cancer treatment. This study aimed to investigate whether receipt of specialized palliative care (SPC) is affected by typical female and male diagnoses (breast and prostate cancer), age, socioeconomic status (SES), comorbidities as measured by the Charlson Comorbidity Index (CCI), or living arrangements (home vs nursing home residence). Furthermore, we wanted to investigate if receipt of SPC affects the place of death, or correlated with emergency department visits, or hospital admissions.
All breast and prostate cancer patients who died with verified distant metastases during 2015-2019 in the Stockholm Region were included (n = 2516). We used univariable and stepwise (forward) logistic multiple regression models.
Lower age, lower CCI score, and higher SES significantly predicted receipt of palliative care 3 months before death (p = .007-p < .0001). Patients with prostate cancer, a lower CCI score, receiving palliative care services, or living in a nursing home were admitted to a hospital or visited an emergency room less often during their last month of life (p = .01 to < .0001). Patients receiving palliative care services had a low likelihood of dying in an acute care hospital (p < .001). Those who died in a hospital were younger, had a lower CCI score, and had received less palliative care or nursing home services (p = .02- < .0001).
Age, comorbidities, and nursing home residence affected the likelihood of receiving SPC. However, the diagnosis of breast versus prostate cancer did not. Emergency room visits, hospital admissions, and hospital deaths are registered less often for patients with SPC.
癌症治疗存在不平等现象。本研究旨在调查是否接受专门的姑息治疗（SPC）受到典型的男性和女性诊断（乳腺癌和前列腺癌）、年龄、社会经济地位（SES）、Charlson 合并症指数（CCI）衡量的合并症或居住安排（家庭与疗养院居住）的影响。此外，我们还想调查接受 SPC 是否会影响死亡地点，或与急诊科就诊或住院相关。
纳入 2015 年至 2019 年期间在斯德哥尔摩地区死于远处转移且经证实的所有乳腺癌和前列腺癌患者（n=2516）。我们使用单变量和逐步（向前）逻辑多元回归模型。
年龄较低、CCI 评分较低和 SES 较高显著预测了死亡前 3 个月接受姑息治疗（p=0.007-p<0.0001）。患有前列腺癌、CCI 评分较低、接受姑息治疗服务或居住在疗养院的患者在生命的最后一个月住院或去急诊室的次数较少（p=0.01 至<0.0001）。接受姑息治疗服务的患者在急性护理医院死亡的可能性较低（p<0.001）。那些在医院死亡的患者年龄较小、CCI 评分较低，并且接受的姑息治疗或疗养院服务较少（p=0.02-<0.0001）。
年龄、合并症和疗养院居住影响接受 SPC 的可能性。然而，乳腺癌与前列腺癌的诊断并没有。接受 SPC 的患者急诊就诊、住院和医院死亡的次数较少。
