Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL.
Pediatric Hematology/Oncology, University of Alabama at Birmingham, Birmingham, AL.
J Clin Oncol. 2024 Feb 20;42(6):755-763. doi: 10.1200/JCO.23.00709. Epub 2023 Oct 20.
Palliative care (PC) aims to improve quality of life (QOL) for patients with serious illness and their families by recognizing and alleviating the physical, emotional, social, existential, and spiritual suffering of patients and their communities. Because adolescents and young adults (AYAs, age 15-39 years) with cancer commonly report distress across all these domains and because that distress translates to their QOL during and after their cancers, PC is particularly relevant for this population. Here, we review the evidence for PC among AYAs with cancer, including its rationale, gaps, opportunities, and implications for care delivery. For example, nearly 90% of AYAs with cancer report distressing symptoms during their treatment, those who survive report ongoing unmet psychosocial and physical health needs, and those who die from their cancers are highly likely to receive medically intense care that is discordant with their goals and values. AYA communication and decision making can be challenging because of ethical and developmental considerations regarding the patient's autonomy and competing priorities of patients and caregivers. PC interventions (including primary PC delivered by oncologists, routine PC subspecialty care, symptom tracking, advance care planning, and psychosocial programs promoting AYA resilience) are all associated with improved patient-centered outcomes. However, PC is inconsistently integrated into AYA oncology care, and access to PC programs is not equitable; marginalized groups continue to experience poorer outcomes. Ongoing and future research and clinical initiatives must continue to bridge these gaps. Improving the QOL of AYAs with cancer is a shared goal of the larger clinical oncology community, and including PC in AYA cancer care delivery can help attain that goal.
姑息治疗（PC）旨在通过识别和缓解患者及其家属的身体、情感、社会、存在和精神痛苦，改善患有严重疾病的患者及其家庭的生活质量（QOL）。由于青少年和年轻成人（AYA，年龄 15-39 岁）癌症患者通常在所有这些领域都报告有困扰，并且这种困扰会转化为他们癌症期间和之后的生活质量，因此 PC 对这一人群特别相关。在这里，我们回顾了针对癌症 AYA 的 PC 证据，包括其原理、差距、机会以及对护理提供的影响。例如，近 90%的癌症 AYA 在治疗期间报告有困扰症状，那些存活下来的人报告有持续未满足的心理社会和身体健康需求，那些死于癌症的人极有可能接受与他们的目标和价值观不一致的高度集中的医疗护理。AYA 的沟通和决策可能具有挑战性，因为涉及到患者自主权的伦理和发展考虑因素，以及患者和照顾者的优先事项之间存在竞争。PC 干预措施（包括由肿瘤学家提供的主要 PC、常规 PC 专科护理、症状跟踪、预先护理计划和促进 AYA 适应力的心理社会项目）都与改善以患者为中心的结果相关。然而，PC 并未一致地融入 AYA 肿瘤学护理中，并且获得 PC 计划的机会并不公平；边缘化群体的预后仍然较差。持续和未来的研究和临床举措必须继续弥合这些差距。提高癌症 AYA 的生活质量是更大的临床肿瘤学社区的共同目标，将 PC 纳入 AYA 癌症护理提供可以帮助实现这一目标。
