Quality End-of-Life Cancer Care: An Unfulfilled but Achievable Imperative.

IF 4.7 2区 医学 Q1 ONCOLOGY
Current Oncology Reports Pub Date : 2025-02-01 Epub Date: 2025-01-03 DOI:10.1007/s11912-024-01618-2
Guy B Faguet
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引用次数: 0

Abstract

Background: Disease-focus management of late-stage cancer without addressing patients' preferences or quality of life (QoL) can lead to unsatisfactory patient and disease outcomes.

Methods: A PRISMA-adherent systematic review of the literature was conducted via PubMed, Embase, Scopus, and Google Scholar to assess the current late-stage cancer treatment modality, setting, timing, and cost, their impact on patient and disease outcomes, and possible interventions for improvement.

Results: Out of many studies, twelve from North America, Western Europe, and Asia met our inclusion criteria. A detailed analysis of the 929,408 late-stage cancer patients included revealed common management practices. Typically, patients were subjected to sustained intensive disease-focused treatment through the end-of-life (EoL) while deferring palliative care and other host-sustaining measures. Such practices compromised patients' QoL and increased costs without meeting their needs and expectations or significantly altering the course of the disease. To forestall such practices, five pragmatic host-focused management principles are proposed. In contrast to clinical practice guidelines (CPG), they can be promoted directly to current and future cancer care professionals as an easy-to-memorize and apply template: to the former via continuing medical education, podcasts, webinars, and other tutorials; to the latter by its incorporation into Oncology, Hematology, Hospice, and other cancer-training programs.

Conclusions: Despite major advances in early-stage cancer treatment and survival, late-stage cancer care is hindered by continuous disease-focused practices pursued through the EoL that lead to unsatisfactory patient and disease outcomes. Such practices can be reversed by adopting host-focused management principles that promote QoL and meet patients' needs and expectations as a basis for delivering holistic cancer care through the EoL.

高质量的临终癌症护理:未实现但可实现的当务之急。
背景:疾病焦点管理晚期癌症没有解决患者的偏好或生活质量(QoL)可能导致不满意的患者和疾病的结果。方法:通过PubMed、Embase、Scopus和谷歌Scholar对文献进行系统回顾,评估当前晚期癌症治疗方式、环境、时间和成本,对患者和疾病结局的影响,以及可能的改善干预措施。结果:在许多研究中,来自北美、西欧和亚洲的12项研究符合我们的纳入标准。对929408名晚期癌症患者的详细分析揭示了共同的管理措施。通常,患者在生命末期(EoL)接受持续强化的疾病治疗,同时推迟姑息治疗和其他维持宿主的措施。这种做法损害了患者的生活质量,增加了费用,而没有满足他们的需求和期望,也没有显著改变疾病的进程。为了防止这种做法,提出了五项以东道国为重点的实用管理原则。与临床实践指南(CPG)相比,它们可以作为易于记忆和应用的模板直接推广给当前和未来的癌症护理专业人员:前者通过继续医学教育、播客、网络研讨会和其他教程;后者通过将其纳入肿瘤学、血液学、临终关怀和其他癌症培训项目。结论:尽管在早期癌症治疗和生存方面取得了重大进展,但通过EoL持续关注疾病的做法阻碍了晚期癌症护理,导致患者和疾病结果不满意。这种做法可以通过采用以宿主为中心的管理原则来扭转,这些原则促进生活质量并满足患者的需求和期望,以此作为通过生活质量提供整体癌症护理的基础。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
8.50
自引率
0.00%
发文量
187
审稿时长
6-12 weeks
期刊介绍: This journal aims to review the most important, recently published clinical findings in the field of oncology. By providing clear, insightful, balanced contributions by international experts, the journal intends to serve all those involved in the care of those affected by cancer. We accomplish this aim by appointing international authorities to serve as Section Editors in key subject areas, such as cancer prevention, leukemia, melanoma, neuro-oncology, and palliative medicine. Section Editors, in turn, select topics for which leading experts contribute comprehensive review articles that emphasize new developments and recently published papers of major importance, highlighted by annotated reference lists. An international Editorial Board reviews the annual table of contents, suggests articles of special interest to their country/region, and ensures that topics are current and include emerging research. Commentaries from well-known figures in the field are also provided.
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