Johnston G M, Gibbons L, Burge F I, Dewar R A, Cummings I, Levy I G
School of Health Services Administration, Dalhousie University, Halifax, NS.
CMAJ. 1998 Jun 30;158(13):1691-8.
To assess the degree to which Nova Scotia cancer patients who may need palliative care are being referred to the comprehensive Halifax-based Palliative Care Program (PCP).
The authors conducted a retrospective, population-based study using administrative health data for all adults in Nova Scotia who died of cancer from 1988 to 1994. Proportions and odds ratios (ORs) were used to determine where there were differences in age, sex, place of residence, cancer cause of death, year of death and use of palliative radiotherapy between those who were referred to the PCP at the Halifax Infirmary and those who were not, and between those who were referred late (within 14 days of death) and those who were referred earlier.
Of the 14,494 adults who died of cancer during the study period, 2057 (14.2%) were registered in the PCP. Within Halifax County, 1582 (36.4%) of the 4340 patients with terminal cancer were seen in the PCP. Predictors of PCP registration were residence in Halifax County (OR 19.2, 95% confidence interval [CI] 15.4-23.9), younger age compared with those 85 years of age or older (for those 20-54 years of age, OR 4.9, 95% CI 3.2-7.6; 55-64 years, OR 3.4, 95% CI 2.2-5.1; 65-74 years, OR 3.1, 95% CI 2.1-4.5; 75-84 years, OR 2.1, 95% CI 1.4-3.1), and having received palliative radiation (OR 1.8, 95% CI 1.5-2.2). PCP referral was associated directly with head and neck cancer (OR 5.4, 95% CI 3.0-9.7) and inversely with hematopoietic (OR 0.2, 95% CI 0.4-0.9), lymph node (OR 0.3, 95% CI 0.1-0.4) and lung (OR 0.6, 95% CI 0.4-0.9) cancer. Predictors of late referral (being referred to the PCP within 14 days of death) were age 65-84 years (OR 1.4, 95% CI 1.1-1.8) and 85 years and over (OR 1.8, 95% CI 1.1-3.0), no palliative radiation (OR 2.0, 95% CI 1.4-3.1) and cancer cause of death. People dying within 6 months of diagnosis were somewhat less likely to have been referred to the PCP (OR 0.8, 95% CI 0.6-0.9), but those who were referred were more likely to have been referred late (OR 2.6, 95% CI 2.0-3.5).
Referral to the PCP and earlier rather than late referral were more likely for younger people with terminal cancer, those who received palliative radiation and those living closer to the PCP. Referral rates also varied by cancer cause of death and the time between diagnosis and death.
评估新斯科舍省可能需要姑息治疗的癌症患者被转介至哈利法克斯综合姑息治疗项目（PCP）的程度。
作者进行了一项基于人群的回顾性研究，使用新斯科舍省1988年至1994年所有死于癌症的成年人的行政健康数据。比例和比值比（OR）用于确定在哈利法克斯医院被转介至PCP的患者与未被转介的患者之间，以及被延迟转介（在死亡前14天内）的患者与较早被转介的患者之间，在年龄、性别、居住地点、癌症死因、死亡年份和姑息性放疗使用方面是否存在差异。
在研究期间死于癌症的14494名成年人中，2057人（14.2%）被登记在PCP中。在哈利法克斯县，4340名晚期癌症患者中有1582人（36.4%）在PCP接受治疗。PCP登记的预测因素包括居住在哈利法克斯县（OR 19.2，95%置信区间[CI] 15.4 - 23.9）、与85岁及以上患者相比年龄较小（20 - 54岁患者，OR 4.9，95% CI 3.2 - 7.6；5� - 64岁患者，OR 3.4，95% CI 2.2 - 5.1；65 - 74岁患者，OR 3.1，95% CI 2.1 - 4.5；75 - 84岁患者，OR 2.1，95% CI 1.4 - 3.1）以及接受过姑息性放疗（OR 1.8，95% CI 1.5 - 2.2）。PCP转介与头颈癌直接相关（OR 5.4，95% CI 3.0 - 9.7），与造血系统癌症（OR 0.2，95% CI 0.4 - 0.9）、淋巴结癌（OR 0.3，95% CI 0.1 - 0.4）和肺癌（OR 0.6，95% CI 0.4 - 0.9）呈负相关。延迟转介（在死亡前14天内被转介至PCP）的预测因素包括年龄在65 - 84岁（OR 1.4，95% CI 1.1 - 1.8）和85岁及以上（OR 1.8，95% CI 1.1 - 3.0）、未接受姑息性放疗（OR 2.0，95% CI 1.4 - 3.1）以及癌症死因。诊断后6个月内死亡的患者被转介至PCP的可能性略低（OR 0.8，95% CI 0.6 - 0.9），但那些被转介的患者更有可能被延迟转介（OR 2.6，95% CI 2.0 - 3.5）。
晚期癌症的年轻患者、接受过姑息性放疗的患者以及居住在离PCP较近的患者更有可能被转介至PCP且较早而非较晚被转介。转介率也因癌症死因以及诊断与死亡之间的时间而有所不同。
