Introduction: Women with late-stage metastatic breast cancer are at an increased risk of pain and distress from symptoms and often struggle with associated emotional and financial burden of their disease. Palliative care is known to alleviate symptom burden in patients with end-stage, terminal diseases but is often underutilized in both inpatient and outpatient settings. The current study aims to investigate the prevalence of palliative care consultation on inpatients with metastatic breast cancer and examine the association between palliative care consultation and length of hospital stay and total hospital charges.Methods: Patients diagnosed with metastatic breast cancer between 1998–2017 were abstracted from the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Database (NIS). The primary outcome was the presence of a palliative care consultation (PCC) during the inpatient stay. Secondary outcomes were hospital length of stay and total hospital charges. Multivariable logistic regression was used to examine factors associated with the presence of a PCC. The relationship between PCC and hospital length of stay and total hospital charges were investigated using linear regression.Results: 513,509 cases of metastatic breast cancer were identified, 5.7% had a documented in-hospital palliative care encounter. Of those who received PCC, total hospital charges were about USD 5452 less than those who did not receive consultation. Women who received PCC had higher odds of a longer hospital stay. Predictors of PCC were older age, non-White race, and residing in a lower-income ZIP code.Conclusions: Palliative care remains to be an underutilized resource among patients with end-stage metastatic breast cancer.
引言：晚期转移性乳腺癌女性患者因症状而面临更高的疼痛和痛苦风险，且常因疾病带来的情感与经济负担而备受困扰。姑息治疗已被证实能够减轻终末期疾病患者的症状负担，但在住院和门诊环境中均未得到充分利用。本研究旨在调查转移性乳腺癌住院患者接受姑息治疗会诊的普遍性，并探讨姑息治疗会诊与住院时间及总医疗费用之间的关联。 方法：研究数据提取自1998年至2017年间医疗成本与利用项目（HCUP）全国住院样本数据库（NIS）中诊断为转移性乳腺癌的患者。主要观察指标为住院期间是否接受姑息治疗会诊，次要观察指标为住院时长和总医疗费用。采用多变量逻辑回归分析探讨与接受姑息治疗会诊相关的因素，并通过线性回归研究姑息治疗会诊与住院时长及总医疗费用之间的关系。 结果：共识别出513,509例转移性乳腺癌病例，其中5.7%有院内姑息治疗记录。接受姑息治疗会诊的患者总医疗费用较未接受会诊者平均减少约5,452美元。接受姑息治疗会诊的女性患者住院时间更长的可能性更高。预测接受姑息治疗会诊的因素包括年龄较大、非白人族群以及居住于较低收入邮政编码区域。 结论：姑息治疗在终末期转移性乳腺癌患者中仍是一种未得到充分利用的医疗资源。
肿瘤(癌症)患者之家