住院胰腺癌患者的姑息治疗、临终关怀利用情况及结局趋势：一项全国性分析。
Trends in Palliative Care, Hospice Utilization, and Outcomes in Hospitalized Pancreatic Cancer Patients: A Nationwide Analysis.
作者信息
Atodaria Kuldeepsinh P, Cohen Steven J, Dhruv Samyak, Ginnaram Shravya R, Shah Shreeja
机构信息
Internal Medicine, Abington Jefferson Health, Abington, USA.
Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, USA.
出版信息
Cureus. 2022 Sep 20;14(9):e29351. doi: 10.7759/cureus.29351. eCollection 2022 Sep.
Background and objective The prognosis of pancreatic cancer (PC) is generally poor. PC responds only modestly to chemotherapy and chemoradiation, and surgical resection remains the only curative option. The risk of recurrence is high. PC patients are encountered in the hospital on initial diagnosis and later for surgeries and complications from PC. We analyzed PC hospitalizations in the United States as reported in the National Inpatient Sample (NIS) database from 2005 to 2011 to determine the extent to which aggressive interventions could be avoided, thereby decreasing the cost of hospitalization. We analyzed trends in palliative care utilization and hospice services. Methods The International Classification of Disease 9th Revision (ICD-9) codes were used to identify diagnoses and procedures performed. Weighted analysis was performed using SPSS Statistics 28.0 (IBM Corp., Armonk, NY). Dispositions at discharge were noted. Complications and procedures performed were also documented. Results A total of 574,522 cases with PC were identified. Trends are reported chronologically (2005 to 2011). Over time, inpatient deaths for PC have decreased (11.2%, 11.1%, 9.8%, 9.8%, 9.5%, 8.4%, 8.1%; p<0.001), and hospice discharges (HD) have increased (10.2%, 11.4%, 11.4%, 12,2%, 12.6%, 12.4%, 12.7%; p<0.001). Palliative care utilization has increased (2.9%, 3.9%, 3.8%, 5.6%, 8.8%, 10.2%, 11.9%; p<0.001). Complications including peritonitis, thrombosis, hypovolemia/shock, and acute kidney injury (AKI) have increased mortality rates and HD. Conclusion There is an increasing trend of palliative care and hospice service utilization among hospitalized PC patients. Until better-targeted treatments and screening become available, mortality and morbidity will remain high. The proportion of patients receiving aggressive interventions remains high and is associated with poor outcomes. It is desirable to conduct palliative care evaluation (PCE) early in patients with advanced disease and avoid aggressive interventions.
背景与目的 胰腺癌（PC）的预后通常较差。PC对化疗和放化疗的反应仅一般，手术切除仍是唯一的治愈选择。复发风险很高。PC患者在初次诊断时以及后来因手术和PC并发症而住院。我们分析了2005年至2011年美国国家住院样本（NIS）数据库中报告的PC住院情况，以确定在多大程度上可以避免积极干预，从而降低住院成本。我们分析了姑息治疗利用和临终关怀服务的趋势。方法 使用国际疾病分类第9版（ICD - 9）编码来识别诊断和所进行的手术。使用SPSS Statistics 28.0（IBM公司，纽约州阿蒙克）进行加权分析。记录出院时的处置情况。还记录了并发症和所进行的手术。结果 共识别出574,522例PC病例。按时间顺序报告趋势（2005年至2011年）。随着时间的推移，PC患者的住院死亡率有所下降（11.2%、11.1%、9.8%、9.8%、9.5%、8.4%、8.1%；p<0.001），临终关怀出院（HD）有所增加（10.2%、11.4%、11.4%、12.2%、12.6%、12.4%、12.7%；p<0.001）。姑息治疗的利用有所增加（2.9%、3.9%、3.8%、5.6%、8.8%、10.2%、11.9%；p<0.001）。包括腹膜炎、血栓形成、低血容量/休克和急性肾损伤（AKI）在内的并发症增加了死亡率和HD。结论 住院PC患者中姑息治疗和临终关怀服务的利用呈上升趋势。在有更好的靶向治疗和筛查方法之前，死亡率和发病率仍将很高。接受积极干预的患者比例仍然很高，且与不良结局相关。对于晚期疾病患者，尽早进行姑息治疗评估（PCE）并避免积极干预是可取的。
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