Chen Xinye, Goh Nicole, Dunn Sadie, Smallwood Natasha
General Medicine, The Alfred Hospital, VIC, Australia.
Respiratory and Sleep Medicine, Austin Hospital, VIC, Australia.
Am J Hosp Palliat Care. 2025 Nov;42(11):1128-1135. doi: 10.1177/10499091241299776. Epub 2024 Nov 12.
BackgroundAdvanced lung diseases are prevalent in women, yet are underrecognized and under-treated due to differing epidemiology and pathophysiology.AimTo investigate any gender differences in access to palliative care and end-of-life management for patients with advanced lung diseases.MethodsA post-hoc analysis was conducted using three datasets that included information regarding the provision of palliative care to patients with advanced lung diseases - chronic obstructive pulmonary disease (COPD), fibrotic interstitial lung diseases (f-ILD) or non-small cell lung cancer (NSCLC) in tertiary and regional hospitals in Victoria, Australia, from 2004 to 2019.Results343 patients with advanced COPD, 67 with f-ILD and 1022 with NSCLC were included. Compared to men, women with COPD (n = 126, 36.7%) were less likely to have smoked ( = 0.024), had significantly worse lung function ( < 0.001), and were more likely to receive non-invasive ventilation at end of life ( = 0.021). Women with fibrotic ILDs (n = 30, 44.8%) had significantly worse lung function ( < 0.001) and were more likely to experience exacerbations during their last two years of life ( < 0.001). Women with NSCLC (n = 457, 44.7%) were significantly younger (< 0.001), less likely to have smoked ( < 0.001) or had asbestos exposure ( < 0.001). There were no significant differences between men and women with advanced lung diseases regarding referral to palliative care services ( = 0.369), hospital place of death ( = 0.915), or end-of-life management.ConclusionsDespite differences in lung function, exacerbations and targeted therapies, men and women with advanced lung diseases received equal access to symptom palliation and palliative care services towards the end of life.
背景
晚期肺部疾病在女性中很常见，但由于流行病学和病理生理学的差异，其未得到充分认识和治疗。
目的
调查晚期肺部疾病患者在获得姑息治疗和临终管理方面是否存在性别差异。
方法
利用三个数据集进行事后分析，这些数据集包含了2004年至2019年澳大利亚维多利亚州三级和地区医院为晚期肺部疾病患者（慢性阻塞性肺疾病（COPD）、纤维化间质性肺疾病（f-ILD）或非小细胞肺癌（NSCLC））提供姑息治疗的相关信息。
结果
纳入了343例晚期COPD患者、67例f-ILD患者和1022例NSCLC患者。与男性相比，COPD女性患者（n = 126，36.7%）吸烟的可能性较小（P = 0.024），肺功能明显较差（P < 0.001），且在临终时接受无创通气的可能性更大（P = 0.021）。纤维化ILD女性患者（n = 30，44.8%）的肺功能明显较差（P < 0.001），且在生命的最后两年更容易出现病情加重（P < 0.001）。NSCLC女性患者（n = 457，44.7%）明显更年轻（P < 0.001），吸烟或接触石棉的可能性较小（P < 0.001）。晚期肺部疾病的男性和女性在转介至姑息治疗服务（P = 0.369）、医院死亡地点（P = 0.915）或临终管理方面没有显著差异。
结论
尽管在肺功能、病情加重和靶向治疗方面存在差异，但晚期肺部疾病的男性和女性在生命末期获得症状缓解和姑息治疗服务的机会均等。
