Introduction: Identifying the complexity of palliative care needs is a key aspect of referral to specialized multidisciplinary early palliative care (EPC) teams. The PALCOM scale is an instrument consisting of five multidimensional assessment domains developed in 2018 and validated in 2023 to identify the level of complexity in patients with advanced cancer. (1) Objectives: The main objective of this study was to determine the degree of instability (likelihood of level change or death), health resource consumption and the survival of patients according to the level of palliative complexity assigned at the baseline visit during a 6-month follow-up. (2) Method: An observational, prospective, multicenter study was conducted using pooled data from the development and validation cohort of the PALCOM scale. The main outcome variables were as follows: (a) instability ratio (IR), defined as the probability of level change or death; (b) emergency department visits; (c) days of hospitalization; (d) hospital death; (e) survival. All the variables were analyzed monthly according to the level of complexity assigned at the baseline visit. (3) Results: A total of 607 patients with advanced cancer were enrolled. According to the PALCOM scale, 20% of patients were classified as low complexity, 50% as medium and 30% as high complexity. The overall IR was 45% in the low complexity group, 68% in the medium complexity group and 78% in the high complexity group (p< 0.001). No significant differences in mean monthly emergency department visits (0.2 visits/ patient/month) were observed between the different levels of complexity. The mean number of days spent in hospital per month was 1.5 in the low complexity group, 1.8 in the medium complexity group and 3.2 in the high complexity group (p< 0.001). The likelihood of in-hospital death was significantly higher in the high complexity group (29%) compared to the medium (16%) and low (8%) complexity groups (p< 0.001). Six-month survival was significantly lower in the high complexity group (24%) compared to the medium (37%) and low (57%) complexity groups (p< 0.001). Conclusion: According to the PALCOM scale, more complex cases are associated with greater instability and use of hospital resources and lower survival. The data also confirm that the PALCOM scale is a consistent and useful tool for describing complexity profiles, targeting referrals to the EPC and managing the intensity of shared care.
引言：识别姑息治疗需求的复杂性是转诊至专业多学科早期姑息治疗团队的关键环节。PALCOM量表是一种包含五个多维评估维度的工具，于2018年开发并于2023年验证，用于评估晚期癌症患者的病情复杂程度。(1) 研究目的：本研究主要目的是根据基线访视时评估的姑息治疗复杂程度，分析患者在6个月随访期内病情不稳定程度（病情分级变化或死亡的可能性）、医疗资源消耗情况及生存状况。(2) 方法：本研究采用观察性、前瞻性、多中心设计，整合了PALCOM量表开发与验证队列的数据。主要结局指标包括：(a) 不稳定比率，定义为病情分级变化或死亡的概率；(b) 急诊就诊次数；(c) 住院天数；(d) 院内死亡；(e) 生存期。所有变量均按月根据基线访视时评定的复杂程度进行分析。(3) 结果：共纳入607例晚期癌症患者。根据PALCOM量表评估，20%患者为低复杂程度，50%为中复杂程度，30%为高复杂程度。低复杂程度组总体不稳定比率为45%，中复杂程度组为68%，高复杂程度组达78%（p<0.001）。不同复杂程度组间月均急诊就诊次数无显著差异（0.2次/患者/月）。低复杂程度组月均住院天数为1.5天，中复杂程度组为1.8天，高复杂程度组达3.2天（p<0.001）。高复杂程度组院内死亡概率（29%）显著高于中复杂程度组（16%）和低复杂程度组（8%）（p<0.001）。高复杂程度组6个月生存率（24%）显著低于中复杂程度组（37%）和低复杂程度组（57%）（p<0.001）。结论：根据PALCOM量表评估，复杂程度更高的病例具有更高的病情不稳定性、更多的住院资源消耗及更低的生存率。数据同时证实PALCOM量表是描述病情复杂程度特征、指导早期姑息治疗转诊及调控协同护理强度的可靠实用工具。
肿瘤(癌症)患者之家