Department of Palliative Care, University Hospital Jena, Friedrich-Schiller University Jena, Jena, Germany.
Comprehensive Cancer Center Central Germany (CCCG), Jena, Deutschland.
J Cancer Res Clin Oncol. 2024 Apr 12;150(4):191. doi: 10.1007/s00432-024-05721-6.
Palliative care (PC) contributes to improved end-of-life care for patients with hematologic malignancies (HM) and solid tumors (ST) by addressing physical and psychological symptoms and spiritual needs. Research on PC in HM vs. ST patients is fragmented and suggests less use.
We analyzed claims data of all deceased members of a large German health insurance provider for the year before death. First, we analyzed the frequency and the beginning of different types of PC and compared patients with HM vs. ST. Second, we analyzed the adjusted impact of PC use on several end-of-life quality outcomes in patients with HM vs. ST. We performed simple and multiple (logistic) regression analysis, adjusted for relevant covariates, and standardized for age and sex.
Of the 222,493 deceased cancer patients from 2016 to 2020, we included 209,321 in the first analysis and 165,020 in the second analysis. Patients with HM vs. ST received PC less often (40.4 vs. 55.6%) and later (34 vs. 50 days before death). PC use significantly improved all six quality indicators for good end-of-life care. HM patients had worse rates in five of the six indicators compared with ST patients. Interaction terms revealed that patients with ST derived greater benefit from PC in five of six quality indicators than those with HM.
The data highlight the need to integrate PC more often, earlier, and more effectively into the care of patients with HM.
姑息治疗（PC）通过解决身体和心理症状以及精神需求，改善了血液恶性肿瘤（HM）和实体瘤（ST）患者的临终护理。对 HM 与 ST 患者的 PC 研究是分散的，表明使用较少。
我们分析了一家德国大型健康保险公司所有已故成员在死亡前一年的索赔数据。首先，我们分析了不同类型 PC 的频率和开始时间，并比较了 HM 与 ST 患者。其次，我们分析了 HM 与 ST 患者中 PC 使用对几种临终质量结果的调整影响。我们进行了简单和多元（逻辑）回归分析，调整了相关协变量，并按年龄和性别进行了标准化。
在 2016 年至 2020 年期间，我们纳入了 222493 名死亡癌症患者中的 209321 名进行了第一次分析，纳入了 165020 名进行了第二次分析。与 ST 患者相比，HM 患者接受 PC 的频率较低（40.4% vs. 55.6%），且时间较晚（死亡前 34 天 vs. 50 天）。PC 使用显著改善了所有 6 项良好临终关怀质量指标。与 ST 患者相比，HM 患者在 6 项指标中的 5 项指标中的比率更差。交互项表明，与 HM 患者相比，ST 患者在 6 项质量指标中的 5 项指标中从 PC 中获益更多。
这些数据强调了需要更频繁、更早、更有效地将 PC 整合到 HM 患者的护理中。
