{"title":"食管癌患者姑息治疗咨询、临终关怀与住院死亡率。","authors":"Suriya Baskar, Udhayvir Singh Grewal","doi":"10.1200/OP-24-01092","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>Palliative care (PC) is an important facet of treatment for patients with advanced esophageal cancer because of symptom burden, low overall 5-year survival rate, and significant impact on quality of life. This patient population experiences high hospitalization burden. The purpose of this study was to analyze the effect of PC on end-of-life (EoL) hospitalizations and evaluate racial differences in EoL care.</p><p><strong>Methods: </strong>The National Inpatient Sample (NIS) was queried between 2016 and 2020 for hospitalizations with esophageal cancer that ended with inpatient death. The primary EoL outcomes that were identified include inpatient PC consultation (PCC), do not resuscitate (DNR) code status, and utilization of certain medical interventions (mechanical ventilation, blood transfusion, vasopressor administration, and chemotherapy). Secondary outcomes include symptom burden, length of stay (LOS), and total hospital charges.</p><p><strong>Results: </strong>Seventeen thousand seven hundred forty-five hospitalizations were included, of which 10,370 (58.4%) received PCCs and 7,375 (41.6%) did not. Age and sex were not significantly different between the patients who did and did not receive PCC. PCC cohort had a higher percentage of White patients (60.9% <i>v</i> 39.1%, <i>P</i> < .001). PCCs resulted in shorter LOS (7.5 <i>v</i> 8.9 days, <i>P</i> < .001), lower mean total hospital charges accumulated ($97,879 in US dollars [USD] <i>v</i> $146,128 [USD], <i>P</i> < .001), and higher rates of DNR code status (78.1% <i>v</i> 43.2%, <i>P</i> < .001). Inpatient PCC was also associated with lower rates of medical interventions (blood transfusions, mechanical ventilation, and chemotherapy). PCC was less likely to be performed among Black patients compared with White patients (adjusted odds ratio [aOR], 0.53 [95% CI, 0.48 to 0.58]). Black patients were also less likely to be DNR compared with White patients (aOR, 0.81 [95% CI, 0.74 to 0.90]).</p><p><strong>Conclusion: </strong>PCCs at EoL were associated with higher rates of DNR and lower rates of medical interventions.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"OP2401092"},"PeriodicalIF":4.6000,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Palliative Care Consultation and End-of-Life Care Among Patients With Esophageal Cancer and Inpatient Mortality.\",\"authors\":\"Suriya Baskar, Udhayvir Singh Grewal\",\"doi\":\"10.1200/OP-24-01092\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>Palliative care (PC) is an important facet of treatment for patients with advanced esophageal cancer because of symptom burden, low overall 5-year survival rate, and significant impact on quality of life. This patient population experiences high hospitalization burden. The purpose of this study was to analyze the effect of PC on end-of-life (EoL) hospitalizations and evaluate racial differences in EoL care.</p><p><strong>Methods: </strong>The National Inpatient Sample (NIS) was queried between 2016 and 2020 for hospitalizations with esophageal cancer that ended with inpatient death. The primary EoL outcomes that were identified include inpatient PC consultation (PCC), do not resuscitate (DNR) code status, and utilization of certain medical interventions (mechanical ventilation, blood transfusion, vasopressor administration, and chemotherapy). Secondary outcomes include symptom burden, length of stay (LOS), and total hospital charges.</p><p><strong>Results: </strong>Seventeen thousand seven hundred forty-five hospitalizations were included, of which 10,370 (58.4%) received PCCs and 7,375 (41.6%) did not. Age and sex were not significantly different between the patients who did and did not receive PCC. PCC cohort had a higher percentage of White patients (60.9% <i>v</i> 39.1%, <i>P</i> < .001). PCCs resulted in shorter LOS (7.5 <i>v</i> 8.9 days, <i>P</i> < .001), lower mean total hospital charges accumulated ($97,879 in US dollars [USD] <i>v</i> $146,128 [USD], <i>P</i> < .001), and higher rates of DNR code status (78.1% <i>v</i> 43.2%, <i>P</i> < .001). Inpatient PCC was also associated with lower rates of medical interventions (blood transfusions, mechanical ventilation, and chemotherapy). PCC was less likely to be performed among Black patients compared with White patients (adjusted odds ratio [aOR], 0.53 [95% CI, 0.48 to 0.58]). Black patients were also less likely to be DNR compared with White patients (aOR, 0.81 [95% CI, 0.74 to 0.90]).</p><p><strong>Conclusion: </strong>PCCs at EoL were associated with higher rates of DNR and lower rates of medical interventions.</p>\",\"PeriodicalId\":14612,\"journal\":{\"name\":\"JCO oncology practice\",\"volume\":\" \",\"pages\":\"OP2401092\"},\"PeriodicalIF\":4.6000,\"publicationDate\":\"2025-09-05\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"JCO oncology practice\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1200/OP-24-01092\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"JCO oncology practice","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1200/OP-24-01092","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ONCOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
目的：姑息治疗（Palliative care， PC）是晚期食管癌患者治疗的一个重要方面，因为晚期食管癌患者的症状负担重，5年总生存率低，对生活质量有显著影响。这一患者群体的住院负担较高。本研究的目的是分析PC对生命末期住院治疗的影响，并评估生命末期护理的种族差异。方法：对2016年至2020年期间以住院死亡结束的食管癌住院患者样本（NIS）进行查询。确定的主要EoL结果包括住院PC咨询（PCC），不复苏（DNR）代码状态，以及某些医疗干预措施（机械通气，输血，血管加压药和化疗）的使用。次要结局包括症状负担、住院时间（LOS）和总住院费用。结果：纳入17745例住院患者，其中10370例（58.4%）接受了PCCs治疗，7375例（41.6%）未接受PCCs治疗。接受和未接受PCC的患者的年龄和性别无显著差异。PCC队列中白人患者的比例较高（60.9% vs 39.1%, P < 0.001）。PCCs导致较短的LOS(7.5天vs 8.9天，P < 0.001)，较低的平均累计医院总费用（97,879美元对146,128美元，P < 0.001），以及较高的DNR代码状态率（78.1% vs 43.2%, P < 0.001）。住院患者PCC还与较低的医疗干预率（输血、机械通气和化疗）有关。与白人患者相比，黑人患者更不可能进行PCC（校正优势比[aOR]， 0.53 [95% CI， 0.48至0.58]）。与白人患者相比，黑人患者发生DNR的可能性也更低（aOR, 0.81 [95% CI， 0.74至0.90]）。结论：在EoL时PCCs与较高的DNR率和较低的医疗干预率相关。
Palliative Care Consultation and End-of-Life Care Among Patients With Esophageal Cancer and Inpatient Mortality.
Purpose: Palliative care (PC) is an important facet of treatment for patients with advanced esophageal cancer because of symptom burden, low overall 5-year survival rate, and significant impact on quality of life. This patient population experiences high hospitalization burden. The purpose of this study was to analyze the effect of PC on end-of-life (EoL) hospitalizations and evaluate racial differences in EoL care.
Methods: The National Inpatient Sample (NIS) was queried between 2016 and 2020 for hospitalizations with esophageal cancer that ended with inpatient death. The primary EoL outcomes that were identified include inpatient PC consultation (PCC), do not resuscitate (DNR) code status, and utilization of certain medical interventions (mechanical ventilation, blood transfusion, vasopressor administration, and chemotherapy). Secondary outcomes include symptom burden, length of stay (LOS), and total hospital charges.
Results: Seventeen thousand seven hundred forty-five hospitalizations were included, of which 10,370 (58.4%) received PCCs and 7,375 (41.6%) did not. Age and sex were not significantly different between the patients who did and did not receive PCC. PCC cohort had a higher percentage of White patients (60.9% v 39.1%, P < .001). PCCs resulted in shorter LOS (7.5 v 8.9 days, P < .001), lower mean total hospital charges accumulated ($97,879 in US dollars [USD] v $146,128 [USD], P < .001), and higher rates of DNR code status (78.1% v 43.2%, P < .001). Inpatient PCC was also associated with lower rates of medical interventions (blood transfusions, mechanical ventilation, and chemotherapy). PCC was less likely to be performed among Black patients compared with White patients (adjusted odds ratio [aOR], 0.53 [95% CI, 0.48 to 0.58]). Black patients were also less likely to be DNR compared with White patients (aOR, 0.81 [95% CI, 0.74 to 0.90]).
Conclusion: PCCs at EoL were associated with higher rates of DNR and lower rates of medical interventions.
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