文章：

接受医疗辅助死亡（MAID）的癌症患者临终症状负担：一项纵向倾向评分匹配队列研究

End-of-Life Symptom Burden among Patients with Cancer Who Were Provided Medical Assistance in Dying (MAID): A Longitudinal Propensity-Score-Matched Cohort Study

原文发布日期：27 March 2024

DOI: 10.3390/cancers16071294

类型: Article

开放获取: 是

英文摘要：

Cancer is the primary underlying condition for most Canadians who are provided Medical Assistance in Dying (MAID). However, it is unknown whether cancer patients who are provided MAID experience disproportionally higher symptom burden compared to those who are not provided MAID. Thus, we used a propensity-score-matched cohort design to evaluate longitudinal symptom trajectories over the last 12 months of patients’ lives, comparing cancer patients in Alberta who were and were not provided MAID. We utilized routinely collected retrospective Patient-Reported Outcomes (PROs) data from the Edmonton Symptom Assessment System (ESAS-r) reported by Albertans with cancer who died between July 2017 and January 2019. The data were analyzed using mixed-effect models for repeated measures to compare differences in symptom trajectories between the cohorts over time. Both cohorts experienced increasing severity in all symptoms in the year prior to death (β from 0.086 to 0.231,p≤ .001 to .002). Those in the MAID cohort reported significantly greater anxiety (β = −0.831,p= .044) and greater lack of appetite (β = −0.934,p= .039) compared to those in the non-MAID cohort. The majority (65.8%) of patients who received MAID submitted their request for MAID within one month of their death. Overall, the MAID patients did not experience disproportionally higher symptom burden. These results emphasize opportunities to address patient suffering for all patients with cancer through routine collection of PROs as well as targeted and early palliative approaches to care.

摘要翻译： 

癌症是加拿大接受医疗辅助死亡（MAID）患者中最主要的潜在疾病。然而，目前尚不清楚接受MAID的癌症患者是否比未接受MAID的患者承受着不成比例更高的症状负担。为此，我们采用倾向评分匹配队列设计，通过比较艾伯塔省接受与未接受MAID的癌症患者，评估其生命最后12个月内的纵向症状轨迹。研究利用2017年7月至2019年1月期间艾伯塔省癌症死亡患者常规收集的回顾性患者报告结局（PROs）数据，这些数据来源于埃德蒙顿症状评估系统修订版（ESAS-r）。采用重复测量的混合效应模型分析数据，以比较两组患者随时间推移的症状轨迹差异。两组患者在死亡前一年内所有症状均呈加重趋势（β值范围0.086至0.231，p≤0.001至0.002）。与未接受MAID的队列相比，MAID队列患者表现出显著更高的焦虑程度（β=-0.831，p=0.044）和更严重的食欲减退（β=-0.934，p=0.039）。大多数（65.8%）接受MAID的患者在死亡前一个月内提交了MAID申请。总体而言，MAID患者并未承受不成比例更高的症状负担。这些结果提示，通过常规收集PROs数据以及实施针对性、早期姑息治疗干预，可为所有癌症患者提供缓解痛苦的新途径。

原文链接：

End-of-Life Symptom Burden among Patients with Cancer Who Were Provided Medical Assistance in Dying (MAID): A Longitudinal Propensity-Score-Matched Cohort Study