Background: The American Society of Clinical Oncology (ASCO) established recommendations for palliative care (PC), and they still remain the most trusted source overall. The standard published by C. Earle (defined in solid tumors) for referral to PC is > 55%. However, these rates remain unclear in general onco-hematology. Our referral rate reaches 60%; while it meets the standard, there are significant differences between ST and HM. Several authors have already pointed out these discrepancies. Arguing in some cases its possible relationship with the different behavior of professionals with different pathologies. Objective: The primary objective of this work is to understand the role that PC plays in onco-hematology and to determine the profile of patients referred to PC. Therefore, the article aims to establish some recommendations related to the results of prevalent characteristics. Methods: The Mortality Subcommittee (MS) includes and registers in a database all cancer patients who died in hospital undergoing systemic anticancer therapy (SACT) in their last 30 days of life (SACT ≤ 30 d). PC, in turn, works on relieving symptoms related to the disease and the patient. To understand the impact of PC in the MS database patients, we reviewed the literature for symptoms related to palliative care activity. Subsequently, we selected some signs and symptoms, by consensus with our PC specialists, in order to add them to the MS database and register them retrospectively. We measured the percentage of patients who registered these symptoms based on the data found in their electronic records. The results include the comparison by group: between patients referred or not to the PC program (PCP), and between the pathologies ST and HM. We used the programming language R (version 4.2) in our statistical analysis, including the “compareGroups” package (version 4.6), applying the pertinent tests based on the distribution of the data. Results: We completed the records on the 1681 patients from the period 2020–2023. 59.4% were men, the average age was 65.5 years, and 73.5% had ST and 26.5% had HM. Patients with lung cancer predominate (28.5%), with 71% of them being in the stage IV, followed by leukemia (9.76%). 60% are in progression of their disease, and 77% have advanced disease (AD). The average therapeutic aggressiveness indicators were SACT < 30 d: 38.9% (ST: 33.4%; HM: 70.97%); SACT < 14 d: 16.36% (ST: 13.76%; HM: 31.56%); the change in therapeutic regimen was 22% (ST: 20.8%; HM: 25.1%). The referral rate to PCP was 59.7% (ST: 68.2% and HM: 36.3%). Late referral (PCP ≤3 days before death) occurred in 29.2% of all patients, being 29% for ST cases and 30.4% for HM cases. Regarding the recording of signs and symptoms: psycho-emotional and analgesia regimens (including opioids) are better recorded in the PCP group (p< 0.001); the more physical symptoms (dyspnea, bleeding, infections, and severe symptoms) do not present statistically significant differences, although the severe symptoms in the PCP group are more disabling (cerebral involvement, spinal cord compression, vertebral crushing). The number of bags of blood products transfused is significantly lower in the PCP group (average 6.9 vs. 12.7). The total number of symptom variables with significant statistical differences was 13 for ST and 8 for HM. Conclusions: In this cohort, patients visited by PC had a better record of psycho-emotional symptoms. We consider that patients who are in any of the following situations should be referred to PC: initial diagnosis of stage IV lung cancer, leukemia; patients with advanced disease; presence of pain requiring opioids; psychoemotional symptoms; need for >7 to 15 transfusions of blood products and, if there are disabling symptoms. PC improves professional interest in the psycho-emotional and fragility situation of these patients. According to our data (in terms of the number of variables with significant differences by pathology group), we observed that hematologists tend to take on palliative tasks more frequently than their oncologist peers, who delegate them to PC in order to have more time dedicated to their specific field.
背景：美国临床肿瘤学会（ASCO）制定了姑息治疗（PC）的推荐标准，至今仍是该领域最受信赖的权威依据。C. Earle提出的实体瘤患者转诊至PC的标准设定为>55%，但这一比例在肿瘤血液学整体领域尚不明确。本中心的转诊率达60%，虽符合标准，但实体瘤（ST）与血液系统恶性肿瘤（HM）患者间存在显著差异，已有学者指出这种差异可能与临床医生对不同病种的处理方式有关。本研究旨在探讨PC在肿瘤血液学中的作用，并明确转诊至PC的患者特征，从而根据主要临床特征提出相应建议。 方法：死亡率分委会（MS）数据库收录了所有在生命最后30天内接受全身抗癌治疗（SACT≤30天）并于院内死亡的癌症患者。PC的核心目标是缓解疾病相关症状与患者痛苦。为评估PC对MS数据库中患者的影响，我们通过文献回顾筛选出与姑息治疗相关的症状指标，经PC专家共识后选取部分症状体征，将其纳入MS数据库进行回顾性登记。根据电子病历记录，统计出现这些症状的患者比例。结果分析比较了转诊与非转诊至PC项目（PCP）的患者，以及ST与HM患者组间的差异。采用R语言（4.2版）进行统计分析，使用"compareGroups"包（4.6版），并根据数据分布特征选用相应检验方法。 结果：共完成2020-2023年间1681例患者的资料登记。男性占59.4%，平均年龄65.5岁，ST与HM患者分别占73.5%和26.5%。肺癌患者占比最高（28.5%），其中71%为IV期；白血病次之（9.76%）。60%患者处于疾病进展期，77%属晚期疾病（AD）。治疗强度指标显示：SACT<30天者平均38.9%（ST:33.4%；HM:70.97%）；SACT<14天者16.36%（ST:13.76%；HM:31.56%）；治疗方案调整率为22%（ST:20.8%；HM:25.1%）。总体PCP转诊率为59.7%（ST:68.2%；HM:36.3%），其中29.2%为临终转诊（死亡前≤3天），ST与HM组分别为29%和30.4%。症状记录分析显示：PCP组在心理情绪症状与镇痛方案（含阿片类药物）的记录更完善（p<0.001）；而呼吸困难、出血、感染等躯体症状虽无统计学差异，但PCP组神经系统受累、脊髓压迫等致残性重症症状更突出。PCP组血制品输注量显著更低（平均6.9袋 vs 12.7袋）。具有统计学差异的症状变量总数在ST组为13项，HM组为8项。 结论：本队列中PC访视患者具有更完善的心理情绪症状记录。建议对以下情况实施PC转诊：初诊IV期肺癌或白血病患者、晚期疾病患者、需阿片类药物镇痛的疼痛患者、出现心理情绪症状者、需输注>7-15袋血制品者以及存在致残性症状者。PC能提升临床医生对患者心理情绪与脆弱状态的关注度。数据显示（基于不同病理组间具有显著差异的变量数量），血液科医生较肿瘤科医生更常承担姑息治疗任务，而肿瘤科医生更倾向于将此类工作转交PC团队以专注于本专业领域。
肿瘤(癌症)患者之家