Division of Palliative Medicine (M.B., K.S., M.P., L.H., D.S.), Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Division of Palliative Medicine (M.B., D.S.), Department of Medicine, University of Toronto, Toronto, ON, Canada; Sunnybrook Research Institute (M.B.), Toronto, ON, Canada.
Division of Palliative Medicine (M.B., K.S., M.P., L.H., D.S.), Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
J Pain Symptom Manage. 2024 Nov;68(5):e373-e381. doi: 10.1016/j.jpainsymman.2024.07.021. Epub 2024 Jul 29.
People with noncancer diagnoses have poorer access to palliative care units (PCUs) or hospices compared to those with cancer diagnoses. The COVID-19 pandemic disrupted how specialist palliative care services were delivered and utilized.
To determine the association between the start of the COVID-19 pandemic and PCU/hospice utilization in hospitalized individuals with cancer and noncancer diagnoses with specialist palliative care needs.
Retrospective cohort study using routinely collected data. Percentages of individuals experiencing each disposition from hospital, including discharge to PCU/hospice, were calculated monthly for the total, cancer, and noncancer cohorts and were analyzed descriptively. Hospitalized individuals with specialist palliative care needs at a single academic hospital in Toronto, Canada from January 1, 2017, to September 31, 2022 (pandemic start was defined as April 1, 2020).
The cohort comprised 4349 individuals (median age=78 years; 52.4% female); 3065 (70.5%) and 1284 (29.5%) had cancer and noncancer diagnoses, respectively. Among individuals with noncancer diagnoses, the most significant absolute changes were a 13.0%-decrease in in-hospital deaths (prepandemic=49.6%; postpandemic=36.6%) and a 11.6%-increase in discharges to PCU/hospice (prepandemic=35.6%; postpandemic=47.3%). Among individuals with cancer, the most significant absolute changes were a 12.8%-increase in discharges home with formal care (prepandemic=2.3%; postpandemic=15.1%) and a 7.0%-decrease in in-hospital deaths (prepandemic=29.1%; postpandemic=22.0%).
Despite historically poor PCU/hospice access, the COVID-19 pandemic created circumstances that may have enabled unprecedented utilization in individuals with noncancer diagnoses in our cohort.
与癌症诊断患者相比，非癌症诊断患者获得姑息治疗病房（PCU）或临终关怀的机会较差。COVID-19 大流行扰乱了专科姑息治疗服务的提供和利用方式。
确定 COVID-19 大流行开始与癌症和非癌症诊断的需要专科姑息治疗的住院患者的 PCU/临终关怀利用之间的关联。
使用常规收集的数据进行回顾性队列研究。每月计算总人群、癌症人群和非癌症人群中从医院出院的患者比例，包括 PCU/临终关怀出院，并用描述性方法进行分析。该研究在加拿大多伦多的一家学术医院进行，时间为 2017 年 1 月 1 日至 2022 年 9 月 31 日（大流行开始定义为 2020 年 4 月 1 日），纳入患有专科姑息治疗需求的住院患者。
该队列包括 4349 名患者（中位数年龄为 78 岁；52.4%为女性）；3065 名（70.5%）和 1284 名（29.5%）患者患有癌症和非癌症诊断。在非癌症诊断患者中，绝对值变化最显著的是院内死亡人数减少 13.0%（大流行前为 49.6%；大流行后为 36.6%）和 PCU/临终关怀出院人数增加 11.6%（大流行前为 35.6%；大流行后为 47.3%）。在癌症患者中，绝对值变化最显著的是有正规照护的居家出院人数增加 12.8%（大流行前为 2.3%；大流行后为 15.1%）和院内死亡人数减少 7.0%（大流行前为 29.1%；大流行后为 22.0%）。
尽管 PCU/临终关怀的机会历来很差，但 COVID-19 大流行创造了条件，可能使我们队列中的非癌症诊断患者的姑息治疗利用达到了前所未有的水平。
