Cassel J Brian, McClish Donna, Buxton David, Yanni Leanne, Roberts Seth, Skoro Nevena, May Peter, Del Fabbro Egidio, Noreika Danielle
Division of Hematology, Oncology and Palliative Care, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia, United States of America.
Department of Biostatistics, Virginia Commonwealth University School of Medicine, Richmond, Virginia, United States of America.
PLoS One. 2025 Jan 13;20(1):e0313732. doi: 10.1371/journal.pone.0313732. eCollection 2025.
Rigorous population-based assessments of the use of specialty palliative care (SPC) in the US are rare.
SETTINGS/SUBJECTS: This study examined SPC use among cancer patients in a mid-sized metropolitan area in Southeast US.
In this cancer decedent cohort study, data were acquired and linked from the state-wide cancer registry; state-wide hospital discharge dataset; and local SPC providers.
12,030 individuals with cancer were included in this study; only 2,958 (24.6%) used SPC. Of the 9,072 persons who did not use SPC, 3,877 (42.7%) went only to hospitals that did not offer SPC; and 3,517 (38.8%) went to hospitals that offered SPC but did not use it. About half of SPC recipients (1493; 50.5%) first received SPC in the final 30 days of life, including 768 (26.0%) in the final week of life. Characteristics associated with using SPC use included being in an socio-economic status quintile other than the lowest; being younger; being Black; having a solid (versus hematological) cancer; having a shorter survival with cancer; dying in the latter two years of the study; being from an area of low or complete rurality; having a hospital admission in the final 60 days prior to initiation of PC or death; having more days in hospital; and living within 15 miles of a hospital offering SPC.
In this population-based study, only one-quarter of cancer patients used SPC, and for half who did so, it came in the final 30 days of life.
在美国，基于严格人群的专科姑息治疗（SPC）使用情况评估很少见。
设置/对象：本研究调查了美国东南部一个中等规模大都市地区癌症患者的SPC使用情况。
在这项癌症死亡队列研究中，数据来自全州癌症登记处、全州医院出院数据集以及当地SPC提供者，并进行了关联。
本研究纳入了12,030名癌症患者；只有2,958人（24.6%）使用了SPC。在未使用SPC的9,072人中，3,877人（42.7%）只去了不提供SPC的医院；3,517人（38.8%）去了提供SPC但未使用的医院。约一半的SPC接受者（1493人；50.5%）在生命的最后30天首次接受SPC，其中768人（26.0%）在生命的最后一周接受。与使用SPC相关的特征包括社会经济地位不在最低五分位数；年龄较小；为黑人；患有实体癌（而非血液癌）；癌症生存期较短；在研究的后两年死亡；来自低农村或完全农村地区；在开始姑息治疗或死亡前的最后60天内有住院记录；住院天数更多；以及居住在提供SPC的医院15英里范围内。
在这项基于人群的研究中，只有四分之一的癌症患者使用了SPC，而使用SPC的患者中有一半是在生命的最后30天接受的。
