Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.
Department, Stockholms Sjukhem Foundation, Stockholm, Sweden.
BMC Palliat Care. 2022 Jul 23;21(1):133. doi: 10.1186/s12904-022-01022-2.
Patients with progressive primary brain tumors commonly develop a spectrum of physical as well as cognitive symptoms. This places a large burden on family members and the condition's complexity often requires frequent health care contacts. We investigated potential associations between sociodemographic or socioeconomic factors, comorbidity or receipt of specialized palliative care (SPC) and acute healthcare utilization in the end-of-life (EOL) phase.
A population-based retrospective study of all adult patients dying with a primary malignant brain tumor as main diagnosis in 2015-2019 in the Stockholm area, the most densely populated region in Sweden (N = 780). Registry data was collected from the Stockholm Region´s central data warehouse (VAL). Outcome variables included emergency room (ER) visits or hospitalizations in the last month of life, or death in acute hospitals. Possible explanatory variables included age, sex, living arrangements (residents in nursing homes versus all others), Charlson Comorbidity Index, socio-economic status (SES) measured by Mosaic groups, and receipt of SPC in the last three months of life. T-tests or Wilcoxon Rank Sum tests were used for comparisons of means of independent groups and Chi-square test for comparison of proportions. Associations were tested by univariable and multivariable logistic regressions calculating odds ratios (OR).
The proportion of patients receiving SPC increased gradually during the last year of life and was 77% in the last 3 months of life. Multivariable analyses showed SPC to be equal in relation to sex and SES, and inversely associated with age (p ≤ 0.01), comorbidity (p = 0.001), and nursing home residency (p < 0.0001). Unplanned ER visits (OR 0.41) and hospitalizations (OR 0.45) during the last month of life were significantly less common among patients receiving SPC, in multivariable analysis (p < 0.001). In accordance, hospital deaths were infrequent in patients receiving SPC (2%) as compared to one in every four patients without SPC (p < 0.0001). Patients with less comorbidity had lower acute healthcare utilization in the last month of life (OR 0.35 to 0.65), whereas age or SES was not significantly associated with acute care utilization. Female sex was associated with a lower likelihood of EOL hospitalization (OR 0.72). Nursing home residency was independently associated with a decreased likelihood of EOL acute healthcare utilization including fewer hospital deaths (OR 0.08-0.54).
Receipt of SPC or nursing home residency was associated with lower acute health care utilization among brain tumor patients. Patients with more severe comorbidities were less likely to receive SPC and required excess acute healthcare in end-of-life and therefore constitute a particularly vulnerable group.
患有进行性原发性脑肿瘤的患者通常会出现一系列身体和认知症状。这给家庭成员带来了很大的负担，而且病情的复杂性通常需要频繁的医疗保健接触。我们研究了社会人口统计学或社会经济学因素、合并症或接受专门的姑息治疗 (SPC) 与生命末期 (EOL) 阶段急性医疗保健利用之间的潜在关联。
这是一项基于人群的回顾性研究，纳入了 2015 年至 2019 年在瑞典人口最稠密的斯德哥尔摩地区死于原发性恶性脑肿瘤的所有成年患者（N=780）。从斯德哥尔摩地区中央数据仓库 (VAL) 收集登记数据。结局变量包括生命最后一个月的急诊室 (ER) 就诊或住院，或在急性医院死亡。可能的解释变量包括年龄、性别、居住安排（居住在养老院的患者与其他患者相比）、Charlson 合并症指数、社会经济地位 (SES) 由马赛克组测量，以及生命最后三个月接受 SPC。独立组之间的均值比较采用 t 检验或 Wilcoxon 秩和检验，比例比较采用卡方检验。通过单变量和多变量逻辑回归计算优势比 (OR) 来检验关联。
在生命的最后一年，接受 SPC 的患者比例逐渐增加，在生命的最后 3 个月中达到 77%。多变量分析显示，SPC 在性别和 SES 方面相等，而与年龄（p≤0.01）、合并症（p=0.001）和养老院居住（p<0.0001）呈负相关。在多变量分析中，生命最后一个月无计划的 ER 就诊（OR 0.41）和住院（OR 0.45）明显较少见（p<0.001）。因此，在接受 SPC 的患者中，医院死亡的情况很少见（2%），而在未接受 SPC 的患者中，每四个患者中就有一个死亡（p<0.0001）。合并症较少的患者在生命的最后一个月急性医疗保健利用率较低（OR 0.35 至 0.65），而年龄或 SES 与急性护理利用率无显著相关性。女性的 EOL 住院可能性较低（OR 0.72）。养老院居住与包括较少医院死亡在内的 EOL 急性医疗保健利用率降低独立相关（OR 0.08-0.54）。
接受 SPC 或养老院居住与脑肿瘤患者的急性医疗保健利用率降低相关。合并症更严重的患者不太可能接受 SPC，并且在生命末期需要更多的急性医疗保健，因此构成了一个特别脆弱的群体。
