Jannello Letizia M, Siech Carolin, Baudo Andrea, de Angelis Mario, DI Bello Francesco, Goyal Jordan A, Tian Zhe, Luzzago Stefano, Mistretta Francesco A, de Lorenzis Elisa, Saad Fred, Chun Felix K, Briganti Alberto, Carmignani Luca, Longo Nicola, de Cobelli Ottavio, Musi Gennaro, Karakiewicz Pierre I
Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada -
Department of Urology, IEO European Institute of Oncology IRCCS, Milan, Italy -
Minerva Endocrinol (Torino). 2024 Sep 30. doi: 10.23736/S2724-6507.24.04185-X.
The use of inpatient palliative care (IPC) in advanced cancer patients represents a well-established guideline recommendation. This study examines the utilization rates and patterns of IPC among patients with metastatic adrenocortical carcinoma (mACC).
Relying on the Nationwide Inpatient Sample database (2007-2019), we tabulated IPC rates in mACC patients. Estimated annual percentage changes (EAPC) analyses as well as multivariable logistic regression models (MLRM) predicting IPC use were fitted.
Of 2040 mACC patients, 238 (12%) received IPC. Overall, the rate of IPC increased from 3.7% to 19.1% between 2007 and 2019 (EAPC +9.6%, P=0.001). During the same period, in-hospital mortality remained unchanged from 12.1 to 13.8% (EAPC 0.1%; P=0.97). Younger age at admission (<60 years; MLRM OR=0.70, P=0.013), solitary metastatic site (OR=0.63; P=0.015), and non-brain metastases (OR=0.62; P=0.033) were all associated with lower IPC use.
In mACC patients, IPC use has increased from a marginal 3.7% to a moderate annual value of 19.1% in the most recent study year. These rates were not driven by a concomitant increase in in-hospital mortality (12.1% to 13.8%; P=0.9). and may be interpreted as an improvement in quality of care. Despite this encouraging increase, some patient characteristics herald lower IPC use. In consequence, younger patients, those with solitary metastatic sites, and non-brain metastases should be carefully considered for IPC to decrease or completely reduce the IPC access barrier maximally.
在晚期癌症患者中使用住院姑息治疗（IPC）是一项既定的指南建议。本研究调查了转移性肾上腺皮质癌（mACC）患者中IPC的使用率和模式。
基于全国住院患者样本数据库（2007 - 2019年），我们统计了mACC患者的IPC率。进行了估计年百分比变化（EAPC）分析以及预测IPC使用情况的多变量逻辑回归模型（MLRM）。
在2040例mACC患者中，238例（12%）接受了IPC。总体而言，2007年至2019年间，IPC率从3.7%增至19.1%（EAPC为 +9.6%，P = 0.001）。同期，住院死亡率从12.1%保持不变至13.8%（EAPC为0.1%；P = 0.97）。入院时年龄较小（<60岁；MLRM，OR = 0.70，P = 0.013）、孤立转移部位（OR = 0.63；P = 0.015）和非脑转移（OR = 0.62；P = 0.033）均与较低的IPC使用率相关。
在mACC患者中，在最近一个研究年度，IPC使用率已从微不足道的3.7%增至适度的年度值19.1%。这些比率并非由住院死亡率的相应增加所驱动（12.1%至13.8%；P = 0.9），可被视为护理质量的改善。尽管有这一令人鼓舞的数据增加，但一些患者特征预示着较低的IPC使用率。因此，对于年轻患者、有孤立转移部位的患者和非脑转移患者，应仔细考虑进行IPC，以最大程度降低或完全消除IPC获取障碍。
