Introduction

Specialized palliative care (SPC) is beneficial towards end of life because of its holistic approach to improve quality of life and comfort of patients and their families. Few studies have described how patient age, sex, comorbidities, and socioeconomic status (SES) are associated with SPC use in nonselective populations who die of cancer. This study aimed to evaluate the use of SPC in the year preceding death by all Norwegian individuals with a recent cancer diagnosis who died of cancer.

Materials and Methods

From nationwide registries, we identified patients with a recent (<5 years) cancer diagnosis who died during 2010–2014. Using binary logistic regression models, we estimated the probability of receiving hospital-based SPC during the last year of life according to individual (age, sex, comorbidity), cancer (stage, type, and months since diagnosis), and SES (e.g., living alone, household income, and education) characteristics.

Results

The analytical sample contained 45,521 patients with a median age at death of 75 years; 46% were women. The probability of receiving hospital-based SPC in the total cohort was 0.43 (95% confidence interval [CI] 0.42–0.43). Use of SPC was higher if patients were younger, female, had limited comorbidity, metastatic disease, had one the following cancer types: colorectal, pancreatic, bladder, kidney, or gastric, were diagnosed more than six months before death, and had higher SES. Adjusted model results suggested that the probability of using SPC in the last year of life for patients aged 80–89 years was 0.31 (95% CI 0.30–0.32), compared to a probability of 0.63 (95% CI 0.61–0.65) for patients aged 50–59 years. For patients ≥90 years, the probability was 0.16 (95% CI 0.15–0.18).

Discussion

Less hospital-based SPC use among older patients, males, and those with lower SES indicates possible under-treatment in these groups. Future studies should be designed to determine the underlying reasons for these observed differences.

中文翻译：

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年龄对死于癌症的患者在生命最后一年使用专业姑息治疗的影响：一项来自挪威的全国性研究

介绍

专业姑息治疗 (SPC) 有助于临终，因为它采用整体方法来改善患者及其家人的生活质量和舒适度。很少有研究描述患者年龄、性别、合并症和社会经济地位 (SES) 如何与死于癌症的非选择性人群中的 SPC 使用相关联。本研究旨在评估所有最近诊断出癌症并死于癌症的挪威人在死亡前一年对 SPC 的使用情况。

材料和方法

我们从全国范围的登记处确定了 2010-2014 年间死亡的近期（<5 年）癌症诊断患者。使用二元逻辑回归模型，我们根据个体（年龄、性别、合并症）、癌症（分期、类型和诊断后的月份）和 SES（例如，独居、家庭收入和教育）特征。

结果

分析样本包含 45,521 名患者，中位死亡年龄为 75 岁；46% 是女性。在整个队列中接受基于医院的 SPC 的概率为 0.43（95% 置信区间 [CI] 0.42–0.43）。如果患者更年轻、女性、有有限的合并症、转移性疾病、患有以下癌症类型之一：结直肠癌、胰腺癌、膀胱癌、肾癌或胃癌，在死亡前六个月以上被诊断出来，并且 SES 更高，则 SPC 的使用率更高. 调整后的模型结果表明，80-89 岁患者在生命最后一年使用 SPC 的概率为 0.31（95% CI 0.30-0.32），而 80-89 岁患者的概率为 0.63（95% CI 0.61-0.65）年龄在 50-59 岁之间。对于 ≥ 90 岁的患者，概率为 0.16 (95% CI 0.15–0.18)。

讨论

在老年患者、男性和 SES 较低的患者中，基于医院的 SPC 使用较少表明这些群体可能存在治疗不足。未来的研究应该旨在确定这些观察到的差异的根本原因。