转移性非小细胞肺癌患者临终前使用全身抗癌治疗的相关因素：一项多中心回顾性队列研究
Associated factors regarding systemic anticancer therapy use prior to death among patients with metastatic non-small cell lung cancer: A multicentre retrospective cohort study.
作者
作者单位
- OLVG Medical Centre, Department of Pulmonology, Oosterpark 9, Amsterdam, the Netherlands.
- OLVG Medical Centre, Department of Pulmonology, Oosterpark 9, Amsterdam, the Netherlands. Electronic address: c.l.breukhoven@olvg.nl.
- Martini Hospital, Department of Pulmonology, Van Swietenplein 1, Groningen, the Netherlands.
- Catharina Medical Centre, Department of Pulmonology, Michelangelolaan 2, Eindhoven, the Netherlands.
- OLVG Medical Centre, Department of Pulmonology, Oosterpark 9, Amsterdam, the Netherlands; Department of Pulmonary Diseases, Amsterdam UMC Location Vrije Universiteit Amsterdam, the Netherlands.
摘要
中文
转移性非小细胞肺癌（NSCLC）患者临终前的全身抗癌治疗（SACT）被认为是潜在不适当临终关怀的人口层面质量指标。我们调查了诊断为转移性NSCLC的患者在生命最后6周内接受SACT的相关因素，以优化临终关怀。在荷兰Santeon网络的7家医院中，对转移性NSCLC患者进行了一项多中心回顾性队列研究。数据从电子健康记录中提取。主要结局是死亡前6周内接受SACT（免疫治疗和/或化疗）。变量包括相关的人口统计学、临床和肿瘤特征、姑息治疗团队参与、急诊科（ED）就诊和住院情况。采用后向选择的多变量逻辑回归来识别相关变量。在纳入的365名患者中，37%在生命最后6周接受了SACT。值得注意的是，这些患者更可能在医院死亡（44.1% vs 9.6%）、前往急诊科（77.9% vs 32.8%）或在生命最后6周内住院（80.1% vs 37.1%）。最后一次治疗前的住院与生命最后6周使用SACT独立相关（OR 2.673（CI 1.317-5.427），p=0.006），而ED就诊在最终模型中被保留，但无统计学意义（OR 1.688，95% CI 0.861-3.311；p=0.128）。本研究强调更好地理解转移性NSCLC患者临终前潜在不适当护理的重要性，特别是在关注既往住院或急诊科就诊时。
English
Systemic anticancer therapy (SACT) near the end of life among patients with metastatic non-small cell lung cancer (NSCLC) is considered a population-level quality indicator of potentially inappropriate end-of-life care. We investigated factors associated with SACT in the final 6 weeks of life among patients diagnosed with metastatic NSCLC to optimise end-of-life care. A multicentre retrospective cohort study was conducted among patients with metastatic NSCLC across 7 hospitals in the Dutch Santeon network. Data were extracted from electronic health records. The primary outcome was the receipt of SACT (immunotherapy and/or chemotherapy) within 6 weeks before death. Variables included relevant demographics, clinical and tumour characteristics, palliative care team involvement, emergency department (ED) visits, and hospitalisations. A multivariable logistic regression with backward selection was employed to identify associated variables. Among 365 included patients, 37 % received SACT in the last 6 weeks of life. Notably, these patients were significantly more likely to die in a hospital (44.1 % vs 9.6 %), to visit the emergency department (77.9 % vs 32.8 %) or to be hospitalised in the last 6 weeks of life (80.1 % vs 37.1 %). Hospitalisations before last treatment were independently associated with SACT use in the last 6 weeks of life (OR 2.673 (CI 1.317-5.427), p = 0.006) whereas ED visits were retained in the final model but were not statistically significant (OR 1.688, 95 % CI 0.861-3.311; p = 0.128). This study highlights the importance of better understanding potentially inappropriate care near the end of life among patients with metastatic NSCLC, specifically when focusing on previous hospitalisations or emergency department visits.
分类与指标
- 研究类型
- 临床研究
- 病种
- 肺癌
- JCR 分区
- Q1
- 影响因子
- 5.3
- 新锐分区
- 2区