Zhang Zidong, Gokul Kaushik, Hinyard Leslie J, Subramaniam Divya S
Advanced HEAlth Data (AHEAD) Institute & Department of Health and Clinical Outcomes, School of Medicine, Saint Louis University, St. Louis, MO 63104, USA.
J Clin Med. 2024 Sep 6;13(17):5286. doi: 10.3390/jcm13175286.
Palliative care has shown benefit in patients with cancer; however, little is known about the overall utilization of palliative care services in patients with pancreatic cancer and the impact of aggressive end-of-life interventions. This study aimed to explore the incidence of palliative care consultations (PCCs) in hospitalized patients with pancreatic cancer in the United States and the association between palliative care consultations and the use of aggressive interventions at the end of life. We conducted a retrospective study of patients hospitalized with pancreatic cancer. We examined patient records for 6 months prior to death for the presence of PCCs and aggressive end-of-life (EOL) interventions-emergency department visits, chemotherapy, and ICU stays. The use of EOL interventions was compared between those who did and those who did not receive PCCs, using Chi-square and Whitney U tests. Of the 2883 identified patients, 858 had evidence of a PCC in their record in the last 6 months of life. Patients receiving PCCs were older at the time of death and more likely to receive chemotherapy (22.4% vs. 10.6%) in the last 6 months of life compared to those not receiving a palliative care consult. Similarly, patients with PCCs were more likely to have aggressive interventions in the EOL period. Less than 30% of patients with pancreatic cancer received a PCC. Those who received a PCC had more aggressive interventions in the end-of-life period, differing from what the prior literature has shown. Future investigations are necessary to explore the components and timing of PC and investigate their influence on the utilization of aggressive interventions and patient-centered outcomes.
姑息治疗已被证明对癌症患者有益；然而，对于胰腺癌患者姑息治疗服务的总体利用情况以及积极的临终干预措施的影响，我们知之甚少。本研究旨在探讨美国住院胰腺癌患者的姑息治疗会诊（PCC）发生率，以及姑息治疗会诊与临终时积极干预措施使用之间的关联。我们对住院的胰腺癌患者进行了一项回顾性研究。我们检查了患者死亡前6个月的病历，以确定是否存在PCC以及积极的临终（EOL）干预措施——急诊科就诊、化疗和入住重症监护病房（ICU）。使用卡方检验和惠特尼U检验，比较接受PCC和未接受PCC的患者使用EOL干预措施的情况。在确定的2883名患者中，858名在生命的最后6个月病历中有PCC的证据。与未接受姑息治疗会诊的患者相比，接受PCC的患者死亡时年龄更大，在生命的最后6个月更有可能接受化疗（22.4%对10.6%）。同样，接受PCC的患者在临终期更有可能接受积极的干预措施。不到30%的胰腺癌患者接受了PCC。接受PCC的患者在临终期有更多积极的干预措施，这与先前的文献报道不同。未来有必要进行调查，以探索姑息治疗的组成部分和时机，并研究它们对积极干预措施的利用和以患者为中心的结果的影响。
