Wachter Claudia, Hackner Klaus, Groissenberger Iris, Jutz Franziska, Tschurlovich Lisa, Le Nguyen-Son, Kreye Gudrun
Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, 3500 Krems, Austria.
Department of Pneumology, University Hospital Krems, Karl Landsteiner University of Health Sciences, 3500 Krems, Austria.
Cancers (Basel). 2022 Oct 12;14(20):4988. doi: 10.3390/cancers14204988.
Timely integration of specialized palliative care (SPC) has been shown to improve cancer patients' quality of life (QoL) and reduced the use of medical services. To evaluate the level of integration of SPC services for patients with advanced small-cell lung cancer (SCLC), we retrospectively analyzed medical records of patients from 2019 to 2021. Regarding the timing of referral to SPC services, we defined four cutoffs for early referral according to the current literature: (a) SPC provided ≤ 60 days after diagnosis; (b) SPC provided ≥ 60 days before death; (c) SPC provided ≥ 30 days before death; and (d) SPC provided ≥ 130 days before death. One hundred and forty-three patients (94.1%) were found to have locally advanced (stage III) or metastatic (stage IV) disease. Sixty-eight were not referred to SPC services (47.6%), whereas 75 patients received SPC (52.4%). We found a significantly higher number of referrals to SPC services for patients with higher ECOG (Eastern Cooperative Oncology Group) (i.e., ECOG ≥ 2) ( = 0.010) and patients with stage IV disease ( ≤ 0.001). The median overall survival (OS) for SCLC stage III/IV patients ( = 143) who did not receive SPC treatment was 17 months (95% CI 8.5-25.5), while those who did receive SPC treatment had a median OS of 8 months (95% CI 6.2-9.8) ( = 0.014). However, when we evaluated patients receiving SPC treatment in a timely manner before death as suggested by the different cutoffs indicated in the literature, they lived significantly longer when referred at a minimum of ≥60 or ≥130 days before death. Based on our findings, we suggest that patients with advanced SCLC should participate in a consultation with a SPC team in a timely manner to ensure a benefit of SPC for this patient group.
及时整合专科姑息治疗(SPC)已被证明可改善癌症患者的生活质量(QoL)并减少医疗服务的使用。为评估晚期小细胞肺癌(SCLC)患者的SPC服务整合水平,我们回顾性分析了2019年至2021年患者的病历。关于转诊至SPC服务的时间,我们根据当前文献定义了四个早期转诊的时间节点:(a)诊断后≤60天提供SPC;(b)死亡前≥60天提供SPC;(c)死亡前≥30天提供SPC;(d)死亡前≥130天提供SPC。143例患者(94.1%)被发现患有局部晚期(III期)或转移性(IV期)疾病。68例未转诊至SPC服务(47.6%),而75例患者接受了SPC(52.4%)。我们发现,东部肿瘤协作组(ECOG)评分较高(即ECOG≥2)的患者(P = 0.010)和IV期疾病患者(P≤0.001)转诊至SPC服务的人数明显更多。未接受SPC治疗的SCLC III/IV期患者(n = 143)的中位总生存期(OS)为17个月(95%CI 8.5 - 25.5),而接受SPC治疗的患者中位OS为8个月(95%CI 6.2 - 9.8)(P = 0.014)。然而,当我们按照文献中指出的不同时间节点评估在死亡前及时接受SPC治疗的患者时,在死亡前至少≥60天或≥130天转诊的患者存活时间明显更长。基于我们的研究结果,我们建议晚期SCLC患者应及时参与SPC团队的会诊,以确保该患者群体能从SPC中获益。