Haupt Eric C, Sharma Ishita, Nguyen Huong Q
Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA.
Department of Geriatric, Palliative Medicine and Continuing Care, Kaiser-Downey Medical Center, Downey, California, USA.
J Palliat Med. 2023 Jun;26(6):843-848. doi: 10.1089/jpm.2022.0267. Epub 2023 Mar 14.
Symptom burden assessment with the Edmonton Symptom Assessment System (ESAS) has been widely studied among patients in outpatient palliative care (OPC), but fewer reports in home-based palliative care (HBPC), and none has assessed the prognostic value of ESAS scores in HBPC. This retrospective cohort study compares symptom burden and its prognostic value in adult patients receiving OPC and HBPC services between January 1, 2019, and June 30, 2021. Patients completed the ESAS at the first OPC consultation ( = 4086) and at admission to HBPC ( = 4087). OPC patients were younger, more likely to have cancer, less likely to have had a recent hospitalization, and had higher adjusted median ESAS scores (28.1 vs. 22.9) compared with HBPC patients (all < 0.001). ESAS was prognostic of survival in both settings (Hazard ratio 1.18-1.64, < 0.01). Symptom burden is an independent prognosticator of survival in HBPC and OPC in this community-based setting.
使用埃德蒙顿症状评估系统（ESAS）进行症状负担评估已在门诊姑息治疗（OPC）患者中得到广泛研究，但在家居姑息治疗（HBPC）中的报告较少，且尚无研究评估ESAS评分在家居姑息治疗中的预后价值。这项回顾性队列研究比较了2019年1月1日至2021年6月30日期间接受门诊姑息治疗和家居姑息治疗服务的成年患者的症状负担及其预后价值。患者在首次门诊姑息治疗咨询时（n = 4086）和入住家居姑息治疗时（n = 4087）完成了ESAS评估。与家居姑息治疗患者相比，门诊姑息治疗患者更年轻，患癌症的可能性更大，近期住院的可能性更小，调整后的ESAS中位数评分更高（28.1对22.9）（所有P < 0.001）。在两种情况下，ESAS都是生存的预后指标（风险比1.18 - 1.64，P < 0.01）。在这个基于社区的环境中，症状负担是家居姑息治疗和门诊姑息治疗中生存的独立预后因素。
