Faculty of Medicine, Department of Palliative and Supportive Care, University of Tsukuba, Tsukuba, Japan.
Department of Preventive Medicine and Public Health, School of Medicine, Keio University, Tokyo, Japan.
PLoS One. 2023 Apr 13;18(4):e0284147. doi: 10.1371/journal.pone.0284147. eCollection 2023.
One primary concern about receiving care at home is that survival might be shortened because the quality and quantity of treatment provided at home will be inferior to that given in the hospital. Although our previous study demonstrated a longer survival of those with home-based palliative care (PC), it lacked adjustment for some potential confounders including symptoms and treatments during the stay. We aimed to compare the survival times among advanced cancer patients receiving home-based and hospital-based PC with adjusting for symptoms and treatments.
We compared survival time of participants who enrolled two multicenter, prospective cohort studies of advanced cancer patients at 45-home-based PC services between July 2017 and December 2017, and at 23-hospital-based PC services between January 2017 and December 2017. We analyzed with stratification by the estimated survival of Days, Weeks, and Months, which were defined by modified Prognosis in Palliative care Study predictor models-A. We conducted a Cox regression analysis with adjusting for potential confounders including symptoms and treatments during the stay.
A total of 2,998 patients were enrolled in both studies and 2,878 patients were analyzed; 988 patients receiving home-based PC and 1,890 receiving hospital-based PC. The survival time of patients receiving home-based PC was significantly longer than that of patients receiving hospital-based PC for the Days Prognosis (estimated median survival time: 10 days [95% CI 8.1-11.8] vs. 9 days [95% CI 8.3-10.4], p = 0.157), the Weeks prognosis (32 days [95% CI 28.9-35.4] vs. 22 days [95% CI 20.3-22.9], p < 0.001), and the Months Prognosis, (65 days [95% CI 58.2-73.2] vs. 32 days [95% CI 28.9-35.4], p < 0.001).
In this cohort of advanced cancer patients with a Weeks or Months prognosis, those receiving home-based PC survived longer than those receiving hospital-based PC after adjusting for symptoms and treatments.
在家中接受治疗的一个主要担忧是，由于在家中提供的治疗的质量和数量可能不如医院，因此生存时间可能会缩短。尽管我们之前的研究表明，接受家庭姑息治疗（PC）的患者的生存时间更长，但该研究缺乏对一些潜在混杂因素的调整，包括住院期间的症状和治疗。我们旨在比较接受家庭和医院 PC 的晚期癌症患者的生存时间，并对症状和治疗进行调整。
我们比较了 2017 年 7 月至 12 月期间在 45 家家庭 PC 服务中心和 2017 年 1 月至 12 月期间在 23 家医院 PC 服务中心接受治疗的晚期癌症患者参加的两项多中心前瞻性队列研究的参与者的生存时间。我们通过修改后的姑息治疗预后研究预测模型-A 定义的天数、周数和月数的估计生存率进行分层分析。我们进行了 Cox 回归分析，对包括住院期间的症状和治疗在内的潜在混杂因素进行了调整。
共有 2998 名患者参加了这两项研究，其中 2878 名患者进行了分析；988 名患者接受家庭 PC，1890 名患者接受医院 PC。接受家庭 PC 的患者的生存时间明显长于接受医院 PC 的患者的生存时间，在 Days 预后（估计中位生存时间：10 天[95%CI8.1-11.8] vs. 9 天[95%CI8.3-10.4]，p=0.157），Weeks 预后（32 天[95%CI28.9-35.4] vs. 22 天[95%CI20.3-22.9]，p<0.001）和 Months 预后（65 天[95%CI58.2-73.2] vs. 32 天[95%CI28.9-35.4]，p<0.001）。
在本队列中，具有 Weeks 或 Months 预后的晚期癌症患者，在调整症状和治疗后，接受家庭 PC 的患者比接受医院 PC 的患者生存时间更长。
