Department of Oncology, Vaasa Central Hospital, Vaasa, Finland.
Department of Radiotherapy, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki, Finland.
BMC Palliat Care. 2023 Apr 10;22(1):39. doi: 10.1186/s12904-023-01154-z.
Palliative care (PC) improves Quality of life and reduces the symptom burden. Aggressive treatments at end of life (EOL) postpone PC. The aim of this single-center retrospective study was to evaluate the timing of the PC decision i.e., termination of cancer-specific treatments and focusing on symptom-centered PC, and its impact on the use of tertiary hospital services at the EOL.
A retrospective cohort study on brain tumor patients, who were treated at the Comprehensive Cancer Center of the Helsinki University Hospital from November 1993 to December 2014 and died between January 2013 and December 2014, were retrospectively reviewed. The analysis comprised 121 patients (76 glioblastoma multiforme, 74 males; mean age 62 years; range 26-89). The decision for PC, emergency department (ED) visits and hospitalizations were collected from hospital records.
The PC decision was made for 78% of the patients. The median survival after diagnosis was 16 months (13 months patients with glioblastoma), and after the PC decision, it was 44 days (range 1-293). 31% of the patients received anticancer treatments within 30 days and 17% within the last 14 day before death. 22% of the patients visited an ED, and 17% were hospitalized during the last 30 days of life. Of the patients who had a PC decision made more than 30 days prior to death, only 4% visited an ED or were hospitalized in a tertiary hospital in the last 30 days of life compared to patients with a late (< 30 days prior to death) or no PC decision (25 patients, 36%).
Every third patient with malignant brain tumors had anticancer treatments during the last month of life with a significant number of ED visits and hospitalizations. Postponing the PC decision to the last month of life increases the risk of tertiary hospital resource use at EOL.
姑息治疗（PC）可提高生活质量并减轻症状负担。在生命末期（EOL）进行积极的治疗会推迟 PC 的实施。本单中心回顾性研究的目的是评估 PC 决策的时机，即终止癌症特异性治疗并专注于以症状为中心的 PC，并评估其对 EOL 三级医院服务使用的影响。
回顾性分析了 1993 年 11 月至 2014 年 12 月在赫尔辛基大学医院综合癌症中心接受治疗并于 2013 年 1 月至 2014 年 12 月期间死亡的脑肿瘤患者的病历资料。共纳入 121 例患者（76 例多形性胶质母细胞瘤，74 例男性；平均年龄 62 岁；范围 26-89 岁）。从医院病历中收集 PC 决策、急诊就诊和住院治疗的信息。
78%的患者做出了 PC 决策。诊断后中位生存期为 16 个月（胶质母细胞瘤患者为 13 个月），PC 决策后为 44 天（范围 1-293 天）。31%的患者在诊断后 30 天内接受了抗癌治疗，17%的患者在死亡前 14 天内接受了治疗。22%的患者在生命的最后 30 天内就诊于急诊，17%的患者在生命的最后 30 天内住院治疗。在死亡前 30 天以上做出 PC 决策的患者中，仅有 4%在生命的最后 30 天内就诊于急诊或在三级医院住院，而在死亡前 30 天内（<30 天）或未做出 PC 决策的患者（25 例，36%）中，这一比例为 25%。
每 3 例恶性脑肿瘤患者中就有 1 例在生命的最后 1 个月内接受了抗癌治疗，且有大量的急诊就诊和住院治疗。将 PC 决策推迟到生命的最后 1 个月会增加在 EOL 时使用三级医院资源的风险。
