Tuca Albert, Viladot Margarita, Carrera Gemma, Llavata Lucia, Barrera Carmen, Chicote Manoli, Marco-Hernández Javier, Padrosa Joan, Zamora-Martínez Carles, Grafia Ignacio, Pascual Anais, Font Carme, Font Elena
Unit of Supportive Care in Cancer, Medical Oncology Department, Hospital Clinic and Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, University of Barcelona, 08036 Barcelona, Spain.
Psychosocial Support Team, "La Caixa" Foundation (EAPS), Clinic Hospital of Barcelona, 08036 Barcelona, Spain.
Cancers (Basel). 2024 Apr 29;16(9):1744. doi: 10.3390/cancers16091744.
Identifying the complexity of palliative care needs is a key aspect of referral to specialized multidisciplinary early palliative care (EPC) teams. The PALCOM scale is an instrument consisting of five multidimensional assessment domains developed in 2018 and validated in 2023 to identify the level of complexity in patients with advanced cancer. (1) Objectives: The main objective of this study was to determine the degree of instability (likelihood of level change or death), health resource consumption and the survival of patients according to the level of palliative complexity assigned at the baseline visit during a 6-month follow-up. (2) Method: An observational, prospective, multicenter study was conducted using pooled data from the development and validation cohort of the PALCOM scale. The main outcome variables were as follows: (a) instability ratio (IR), defined as the probability of level change or death; (b) emergency department visits; (c) days of hospitalization; (d) hospital death; (e) survival. All the variables were analyzed monthly according to the level of complexity assigned at the baseline visit. (3) Results: A total of 607 patients with advanced cancer were enrolled. According to the PALCOM scale, 20% of patients were classified as low complexity, 50% as medium and 30% as high complexity. The overall IR was 45% in the low complexity group, 68% in the medium complexity group and 78% in the high complexity group ( < 0.001). No significant differences in mean monthly emergency department visits (0.2 visits/ patient/month) were observed between the different levels of complexity. The mean number of days spent in hospital per month was 1.5 in the low complexity group, 1.8 in the medium complexity group and 3.2 in the high complexity group ( < 0.001). The likelihood of in-hospital death was significantly higher in the high complexity group (29%) compared to the medium (16%) and low (8%) complexity groups ( < 0.001). Six-month survival was significantly lower in the high complexity group (24%) compared to the medium (37%) and low (57%) complexity groups ( < 0.001).
According to the PALCOM scale, more complex cases are associated with greater instability and use of hospital resources and lower survival. The data also confirm that the PALCOM scale is a consistent and useful tool for describing complexity profiles, targeting referrals to the EPC and managing the intensity of shared care.
识别姑息治疗需求的复杂性是转介至专业多学科早期姑息治疗（EPC）团队的关键环节。PALCOM量表是一种由五个多维度评估领域组成的工具，于2018年开发，并于2023年得到验证，用于识别晚期癌症患者的复杂程度。（1）目的：本研究的主要目的是根据基线访视时分配的姑息治疗复杂程度，确定患者在6个月随访期间的不稳定程度（水平变化或死亡的可能性）、卫生资源消耗和生存率。（2）方法：使用PALCOM量表开发和验证队列的汇总数据进行了一项观察性、前瞻性、多中心研究。主要结局变量如下：（a）不稳定率（IR），定义为水平变化或死亡的概率；（b）急诊就诊次数；（c）住院天数；（d）院内死亡；（e）生存率。所有变量均根据基线访视时分配的复杂程度每月进行分析。（3）结果：共纳入607例晚期癌症患者。根据PALCOM量表，20%的患者被归类为低复杂程度，50%为中等复杂程度，30%为高复杂程度。低复杂程度组的总体IR为45%，中等复杂程度组为68%，高复杂程度组为78%（<0.001）。不同复杂程度水平之间在平均每月急诊就诊次数（0.2次/患者/月）方面未观察到显著差异。低复杂程度组每月平均住院天数为1.5天，中等复杂程度组为1.8天，高复杂程度组为3.2天（<0.001）。高复杂程度组的院内死亡可能性（29%）显著高于中等（16%）和低（8%）复杂程度组（<0.001）。高复杂程度组的6个月生存率（24%）显著低于中等（37%）和低（57%）复杂程度组（<0.001）。
根据PALCOM量表，更复杂的病例与更高的不稳定性、医院资源使用以及更低的生存率相关。数据还证实，PALCOM量表是描述复杂程度概况、针对EPC进行转介以及管理共享护理强度的一种连贯且有用的工具。
