衰弱对癌症患者接受姑息治疗、急诊就诊和医院死亡的影响：一项基于登记的研究。
The Impact of Frailty on Palliative Care Receipt, Emergency Room Visits and Hospital Deaths in Cancer Patients: A Registry-Based Study.
机构信息
Department of Oncology-Pathology, Karolinska Institutet, Stockholms Sjukhem Foundation, Mariebergsgatan 22, SE 112 19 Stockholm, Sweden.
Research and Development Department, Stockholm's Sjukhem Foundation, Mariebergsgatan 22, SE 112 19 Stockholm, Sweden.
出版信息
Curr Oncol. 2023 Jul 11;30(7):6623-6633. doi: 10.3390/curroncol30070486.
BACKGROUND
Eastern Cooperative Oncology Group (ECOG) performance status is used in decision-making to identify fragile patients, despite the development of new and possibly more reliable measures. This study aimed to examine the impact of frailty on end-of-life healthcare utilization in deceased cancer patients.
METHOD
Hospital Frailty Risk Scores (HFRS) were calculated based on 109 weighted International Classification of Diseases 10th revision (ICD-10) diagnoses, and HFRS was related to (a) receipt of specialized palliative care, (b) unplanned emergency room (ER) visits during the last month of life, and (c) acute hospital deaths.
RESULTS
A total of 20,431 deceased cancer patients in ordinary accommodations were studied (nursing home residents were excluded). Frailty, as defined by the HFRS, was more common in men than in women (42% vs. 38%, < 0.001) and in people residing in less affluent residential areas (42% vs. 39%, < 0.001). Patients with frailty were older (74.1 years vs. 70.4 years, < 0.001). They received specialized palliative care (SPC) less often (76% vs. 81%, < 0.001) but had more unplanned ER visits (50% vs. 35%, < 0.001), and died more often in acute hospital settings (22% vs. 15%, < 0.001). In multiple logistic regression models, the odds ratio (OR) was higher for frail people concerning ER visits (OR 1.81 (1.71-1.92), < 0.001) and hospital deaths (OR 1.66 (1.51-1.81), < 0.001), also in adjusted models, when controlled for age, sex, socioeconomic status at the area level, and for receipt of SPC.
CONCLUSION
Frailty, as measured by the HFRS, significantly affects end-of-life cancer patients and should be considered in oncologic decision-making.
背景
尽管已经开发出了新的、可能更可靠的指标，但东部肿瘤协作组（ECOG）的体能状态仍被用于决策，以识别脆弱的患者。本研究旨在探讨衰弱对死亡癌症患者临终医疗保健利用的影响。
方法
根据 109 个加权的国际疾病分类第 10 版（ICD-10）诊断，计算医院衰弱风险评分（HFRS），并将 HFRS 与以下方面相关联：（a）接受专门的姑息治疗；（b）生命最后一个月内无计划的急诊室（ER）就诊；（c）急性医院死亡。
结果
共研究了 20431 名普通病房死亡的癌症患者（不包括养老院居民）。HFRS 定义的衰弱在男性中比在女性中更为常见（42%比 38%，<0.001），在居住在较贫困地区的人群中更为常见（42%比 39%，<0.001）。衰弱患者年龄较大（74.1 岁比 70.4 岁，<0.001）。他们接受专门的姑息治疗（SPC）的比例较低（76%比 81%，<0.001），但无计划的 ER 就诊更多（50%比 35%，<0.001），在急性医院环境中死亡的比例更高（22%比 15%，<0.001）。在多变量逻辑回归模型中，衰弱患者的急诊就诊（比值比[OR]1.81[1.71-1.92]，<0.001）和医院死亡（OR 1.66[1.51-1.81]，<0.001）的比值更高，即使在调整了年龄、性别、地区层面的社会经济地位以及接受 SPC 后，这一结果仍然具有统计学意义。
结论
HFRS 测量的衰弱状态显著影响终末期癌症患者，应在肿瘤学决策中考虑。
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