Early Specialist Palliative Care in Patients with Metastatic Cancer: A Population-Based Cohort Study

IF 3.5 2区医学 Q2 CLINICAL NEUROLOGY

Journal of pain and symptom management Pub Date : 2025-04-17 DOI:10.1016/j.jpainsymman.2025.04.005

Ling Guo MD, MPH , Thomas W. LeBlanc MD, MA, MHS , Cardinale B. Smith MD, PhD , R. Sean Morrison MD , May Hua MD, MS

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Abstract

Context

Although early integration of specialist palliative care (PC) is recommended for patients with advanced cancer, how frequently these guidelines are followed is unknown.

Objective

To examine use of early PC in real-world settings.

Methods

Retrospective cohort study of patients with a first diagnosis of metastatic cancer who received care in U.S. hospitals with PC programs that participated in the National Palliative Care Registry in 2018–2019. The primary outcome was the proportion of early specialist PC initiation (within eight weeks of a first metastatic cancer diagnosis) overall and after stratification by cancer type. Patient, hospital and PC program characteristics were compared between patients who received early PC, late PC, and no PC.

Results

Of 171,224 patients, 14.1% received PC during the study period. Only 8.0% of patients received early PC. Proportions of early PC were highest for patients with lung cancer, and lowest for patients with breast cancer (12.0% vs. 4.3%). Patients who received early PC had more comorbidities, diagnoses for symptoms or psychiatric conditions, and complications of cancer, and were more likely to have had a serious hospitalization in the prior 12 months. Hospital and program characteristics were not substantially different between patients who did and did not receive early specialist PC.

Conclusion

A low proportion of patients with metastatic cancer received early specialist PC, demonstrating a significant gap in guideline-concordant delivery of specialist PC. Patients who received early PC were substantially different from those who did not, suggesting that its use is targeted to patients with specific characteristics.

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转移性癌症患者早期专科姑息治疗：一项基于人群的队列研究

背景：尽管晚期癌症患者推荐早期整合专科姑息治疗（PC），但这些指南的执行频率尚不清楚。目的：研究早期PC在现实世界中的使用情况。方法：回顾性队列研究首次诊断为转移性癌症的患者，这些患者在2018-2019年参加国家姑息治疗登记处的美国PC项目医院接受治疗。主要结果是早期专科PC起始（首次转移癌诊断后8周内）的总体比例和癌症类型分层后的比例。比较早期、晚期和未接受PC的患者的患者、医院和PC程序的特征。结果：在171,224例患者中，14.1%在研究期间接受了PC治疗。只有8.0%的患者接受了早期PC治疗。早期PC的比例在肺癌患者中最高，在乳腺癌患者中最低（12.0%对4.3%）。接受早期PC治疗的患者有更多的合并症、症状或精神疾病的诊断和癌症并发症，并且更有可能在前12个月内严重住院治疗。在接受和未接受早期专科PC治疗的患者之间，医院和项目特征没有实质性差异。结论：转移性癌症患者早期接受专科前列腺癌治疗的比例较低，这表明专科前列腺癌治疗与指南的一致性存在显著差距。早期接受PC治疗的患者与未接受PC治疗的患者有很大不同，这表明它的使用是针对具有特定特征的患者的。

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

Journal of pain and symptom management 医学-临床神经学

CiteScore

8.90

自引率

6.40%

发文量

821

审稿时长

26 days

期刊介绍： The Journal of Pain and Symptom Management is an internationally respected, peer-reviewed journal and serves an interdisciplinary audience of professionals by providing a forum for the publication of the latest clinical research and best practices related to the relief of illness burden among patients afflicted with serious or life-threatening illness.