Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Whiting School of Engineering, Johns Hopkins University, Baltimore, Maryland, USA.
Neurosurgery. 2023 Aug 1;93(2):419-426. doi: 10.1227/neu.0000000000002428. Epub 2023 Mar 3.
Recent advances in treatment of malignant brain tumors have improved outcomes. However, patients continue to experience significant disability. Palliative care helps patients with advanced illnesses improve their quality of life. There is a paucity of clinical studies examining palliative care usage among patients with malignant brain tumors.
To assess if there were any patterns in palliative care utilization among patients hospitalized with malignant brain tumors.
A retrospective cohort representing hospitalizations for malignant brain tumors was created from The National Inpatient Sample (2016-2019). Palliative care utilization was identified by ICD-10 code. Univariable and multivariable logistic regression models, accounting for the sample design, were built to evaluate the demographic variables associated with palliative care consultation in all patients and fatal hospitalizations.
375 010 patients admitted with a malignant brain tumor were included in this study. Over the whole cohort, 15.0% of patients used palliative care. In fatal hospitalizations, Black and Hispanic patients had 28% lower odds of receiving a palliative care consultation compared with White patients (odds ratio for both = 0.72; P = .02). For fatal hospitalizations, patients insured privately were 34% more likely to use palliative care services compared with patients insured with Medicare (odds ratio = 1.34, P = .006).
Palliative care is underutilized among all patients with malignant brain tumors. Within this population, disparities in utilization are exacerbated by sociodemographic factors. Prospective studies investigating utilization disparities across race and insurance status are necessary to improve access to palliative care services for this population.
恶性脑肿瘤治疗的最新进展改善了预后。然而，患者仍面临严重的残疾。姑息治疗可以帮助晚期疾病患者提高生活质量。目前，关于恶性脑肿瘤患者姑息治疗使用情况的临床研究较少。
评估恶性脑肿瘤住院患者姑息治疗使用是否存在模式。
从国家住院患者样本（2016-2019 年）中创建了一个代表恶性脑肿瘤住院患者的回顾性队列。姑息治疗的使用通过 ICD-10 代码来确定。使用单变量和多变量逻辑回归模型，考虑样本设计，评估所有患者和致命性住院患者姑息治疗咨询相关的人口统计学变量。
本研究共纳入 375010 例患有恶性脑肿瘤的患者。在整个队列中，15.0%的患者使用了姑息治疗。在致命性住院患者中，黑人和西班牙裔患者接受姑息治疗咨询的可能性比白人患者低 28%（两者的优势比均为 0.72；P =.02）。对于致命性住院患者，私人保险患者使用姑息治疗服务的可能性比医疗保险患者高 34%（比值比=1.34，P =.006）。
恶性脑肿瘤患者姑息治疗的使用率较低。在这一人群中，利用姑息治疗服务的差异因社会人口因素而加剧。需要进行前瞻性研究，以调查种族和保险状况对利用姑息治疗服务的差异，从而改善该人群对姑息治疗服务的获取。
