Nortey Joel, Zhu Shiyun, Lynch Andrew, Whitehead Hannah, Ramalingam Nirmala, Liu Raymond
Department of Hematology/Oncology, Kaiser Permanente Northern California, San Franciso, CA, USA.
Division of Research, Kaiser Permanente Northern California, Pleasanton, CA, USA.
Support Care Cancer. 2025 Jul 19;33(8):706. doi: 10.1007/s00520-025-09711-3.
Patients with advanced cancer often experience severe symptoms that significantly impact their quality of life, leading to frequent emergency department visits for pain management. These visits not only diminish patient quality of life, but also impose substantial costs on the healthcare system. While palliative care (PC) has been shown to improve quality of life in cancer patients, its impact on reducing ED utilization for pain remains unclear. This study aimed to evaluate the relationship between PC and ED utilization for pain management in advanced cancer patients within a large integrated healthcare system.
We conducted a retrospective cross-sectional study involving adults aged 18 + diagnosed with stage IV cancer who died within 1 year of diagnosis, stratified by outpatient PC enrollment. Data were obtained from the Kaiser Permanente Northern California database, from January 1, 2015, to June 30, 2022. Multivariable Poisson regression models were used to analyze the prevalence of any opioid use during ED visits and cumulative ED visits with opioid use, adjusting for socio-demographics, clinical characteristics, and high-dimensional propensity scores.
The study included 4739 stage IV cancer patients with a total of 12,727 ED visits during their final year of life. Of these, 2243 (47%) received PC. Patients receiving PC had a 24% to 31% lower prevalence of any opioid administration during ED visits across different models, adjusting for baseline characteristics. Additionally, PC was associated with lower cumulative number of ED visits with opioid administration (PRR 0.83, 95% CI, 0.77-0.89).
Our study highlights the significant role that PC can play in reducing ED utilization for pain management needs among advanced cancer patients, improving quality of life and alleviating healthcare burdens. These findings underscore the importance of prioritizing access to PC and future research should focus on prospective studies to further explore the causal relationships and optimize PC delivery across diverse healthcare settings.
晚期癌症患者常经历严重症状，这对其生活质量有显著影响，导致频繁前往急诊科进行疼痛管理。这些就诊不仅降低了患者生活质量，还给医疗系统带来巨大成本。虽然姑息治疗（PC）已被证明可改善癌症患者生活质量，但其对减少因疼痛而前往急诊科就诊的影响仍不明确。本研究旨在评估在一个大型综合医疗系统中，姑息治疗与晚期癌症患者因疼痛管理而前往急诊科就诊之间的关系。
我们进行了一项回顾性横断面研究，纳入年龄在18岁及以上、被诊断为IV期癌症且在诊断后1年内死亡的成年人，并按门诊姑息治疗登记情况进行分层。数据来自北加利福尼亚凯撒医疗集团数据库，时间跨度为2015年1月1日至2022年6月30日。使用多变量泊松回归模型分析急诊科就诊期间任何阿片类药物使用的患病率以及使用阿片类药物的累积急诊科就诊次数，并对社会人口统计学、临床特征和高维倾向评分进行调整。
该研究纳入了4739例IV期癌症患者，在其生命的最后一年共进行了12,727次急诊科就诊。其中，2243例（47%）接受了姑息治疗。在不同模型中，调整基线特征后，接受姑息治疗的患者在急诊科就诊期间任何阿片类药物给药的患病率降低了24%至31%。此外，姑息治疗与使用阿片类药物的累积急诊科就诊次数减少相关（PRR 0.83，95% CI，0.77 - 0.89）。
我们的研究强调了姑息治疗在减少晚期癌症患者因疼痛管理需求而前往急诊科就诊方面可发挥的重要作用，改善了生活质量并减轻了医疗负担。这些发现强调了优先提供姑息治疗的重要性，未来研究应聚焦于前瞻性研究，以进一步探索因果关系并优化不同医疗环境下的姑息治疗服务。
