晚期癌症患者症状与医疗利用及死亡的相关性。
Associations between symptoms with healthcare utilization and death in advanced cancer patients.
机构信息
Case Western Reserve University School of Medicine, 21300 Cornell Rd, Cleveland, OH, 44106, USA.
University Hospitals, 11100 Euclid Ave, Cleveland, OH, 44106, USA.
出版信息
Support Care Cancer. 2023 Feb 23;31(3):183. doi: 10.1007/s00520-023-07618-5.
INTRODUCTION
There is limited data about assessments that are associated with increased utilization of medical services among advanced oncology patients (AOPs). We aimed to identify factors related to healthcare utilization and death in AOP.
METHODS
AOPs at a comprehensive cancer center were enrolled in a Center for Medicare and Medicaid Innovation program. Participants completed the Edmonton Symptom Assessment Scale (ESAS) and the Functional Assessment of Cancer Therapy-General (FACT-G) scale. We examined factors associated with palliative care (PC), acute care (AC), emergency room (ER), hospital admissions (HA), and death.
RESULTS
In all, 817 AOPs were included in these analyses with a median age of 69. They were generally female (58.7%), white (61.4%), stage IV (51.6%), and represented common cancers (31.5% GI, 25.2% thoracic, 14.3% gynecologic). ESAS pain, anxiety, and total score were related to more PC visits (B=0.31, 95% CI [0.21, 0.40], p<0.001; B=0.24 [0.12, 0.36], p<0.001; and B=0.038 [0.02, 0.06], p=0.001, respectively). Total FACT-G score and physical subscale were related to total PC visits (B=-0.021 [-0.037, -0.006], p=0.008 and B=-0.181 [-0.246, -0.117], p<0.001, respectively). Lower FACT-G social subscale scores were related to more ER visits (B=-0.03 [-0.53, -0.004], p=0.024), while increased tiredness was associated with fewer AC visits (B=-0.039 [-0.073, -0.006], p=0.023). Higher total ESAS scores were related to death within 30 days (OR=0.87 [0.76, 0.98], p=0.027).
CONCLUSIONS
The ESAS and FACT-G assessments were linked to PC and AC visits and death. These assessments may be useful for identifying AOPs that would benefit from routine PC.
简介
关于与晚期肿瘤患者（AOP）医疗服务利用增加相关的评估，数据有限。我们旨在确定与 AOP 医疗利用和死亡相关的因素。
方法
综合癌症中心的 AOP 参加了医疗保险和医疗补助创新中心的一个项目。参与者完成了埃德蒙顿症状评估量表（ESAS）和癌症治疗功能评估一般量表（FACT-G）。我们研究了与姑息治疗（PC）、急性护理（AC）、急诊室（ER）、住院（HA）和死亡相关的因素。
结果
共纳入 817 例 AOP 进行这些分析，中位年龄为 69 岁。他们通常为女性（58.7%）、白人（61.4%）、IV 期（51.6%），代表常见癌症（31.5%胃肠道，25.2%胸部，14.3%妇科）。ESAS 疼痛、焦虑和总分与更多的 PC 就诊次数有关（B=0.31，95%CI[0.21，0.40]，p<0.001；B=0.24[0.12，0.36]，p<0.001；B=0.038[0.02，0.06]，p=0.001）。总 FACT-G 评分和身体子量表与总 PC 就诊次数相关（B=-0.021[-0.037，-0.006]，p=0.008 和 B=-0.181[-0.246，-0.117]，p<0.001）。较低的 FACT-G 社会子量表分数与更多的 ER 就诊次数有关（B=-0.03[-0.53，-0.004]，p=0.024），而疲劳增加与较少的 AC 就诊次数有关（B=-0.039[-0.073，-0.006]，p=0.023）。较高的总 ESAS 评分与 30 天内死亡相关（OR=0.87[0.76，0.98]，p=0.027）。
结论
ESAS 和 FACT-G 评估与 PC 和 AC 就诊次数和死亡相关。这些评估可能有助于识别需要常规 PC 的 AOP。
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