Kawahara Tatsuyuki, Ochi Nobuaki, Kirishi Hirohito, Sunada Yusuke, Mimura Ayaka, Ichiyama Naruhiko, Kosaka Yoko, Nagasaki Yasunari, Nakanishi Hidekazu, Yamane Hiromichi, Takigawa Nagio
Department of General Internal Medicine 4, Kawasaki Medical School, Okayama 701-0192, Japan.
J Pers Med. 2025 Aug 1;15(8):339. doi: 10.3390/jpm15080339.
: Lung cancer remains one of the leading causes of cancer-related mortality worldwide. While most diagnoses occur in outpatient settings, a subset of cases are incidentally identified during emergency department (ED) visits. The clinical characteristics and treatment decisions of these patients, particularly in relation to social background factors such as living situation and access to primary care, remain poorly understood. : We conducted a retrospective study of patients diagnosed with malignancies in the ED of a single institution between April 2018 and December 2021. Patients diagnosed with lung cancer within 60 days of an ED visit were included. Data on demographics, disease status, treatment decisions, and background factors-including whether patients lived alone or had a primary care physician (PCP)-were extracted and analyzed. : Among 32,108 patients who visited the ED, 148 were diagnosed with malignancy within 60 days; 23 had lung cancer. Of these, 69.6% had metastatic disease at diagnosis, and 60.9% received active treatment (surgery or chemotherapy). No significant associations were observed between the extent of disease and either living arrangement or PCP status. However, the presence of a PCP was significantly associated with the selection of best supportive care ( = 0.023). No significant difference in treatment decisions was observed based on age (cutoff: 75 years). : Although social background factors such as living alone were not significantly associated with cancer stage or treatment choice, the presence of a primary care physician was associated with a higher likelihood of best supportive care being selected. This may indicate that patients with an established PCP have more clearly defined care goals at the end of life. These findings suggest that primary care access may play a role in shaping end-of-life care preferences, highlighting the importance of personalized approaches in acute oncology care.
肺癌仍然是全球癌症相关死亡的主要原因之一。虽然大多数诊断是在门诊进行的，但有一部分病例是在急诊科就诊时偶然发现的。这些患者的临床特征和治疗决策，尤其是与生活状况和获得初级医疗服务等社会背景因素相关的情况，仍知之甚少。
我们对2018年4月至2021年12月期间在一家机构急诊科被诊断为恶性肿瘤的患者进行了一项回顾性研究。纳入在急诊科就诊后60天内被诊断为肺癌的患者。提取并分析了人口统计学、疾病状况、治疗决策和背景因素的数据，包括患者是否独居或有初级保健医生（PCP）。
在32108名就诊于急诊科的患者中，148人在60天内被诊断为恶性肿瘤；23人患有肺癌。其中，69.6%在诊断时已有转移性疾病，60.9%接受了积极治疗（手术或化疗）。在疾病程度与生活安排或初级保健医生状况之间未观察到显著关联。然而，初级保健医生的存在与选择最佳支持治疗显著相关（P = 0.023）。基于年龄（临界值：75岁）在治疗决策上未观察到显著差异。
虽然独居等社会背景因素与癌症分期或治疗选择没有显著关联，但初级保健医生的存在与选择最佳支持治疗的可能性较高相关。这可能表明有固定初级保健医生的患者在生命末期有更明确的护理目标。这些发现表明，获得初级医疗服务可能在塑造临终护理偏好方面发挥作用，突出了急性肿瘤护理中个性化方法的重要性。
