背景:全身治疗和放疗并发症导致的住院给患者带来了巨大的负担,社会,和医疗保健系统。制定预防策略和加强病人护理,了解并发症与后续住院需求之间的联系至关重要。这篇综述旨在评估与癌症的全身和放射治疗相关的并发症的现有文献。以及它们对住院率的影响。
方法:数据是通过PubMed的电子搜索获得的,Scopus,Embase和GoogleScholar在线数据库为2000年1月1日至2023年8月30日之间发表的研究选择相关的同行评审论文。我们在电子数据库中搜索了关键词的组合,并使用标准形式从每篇文章中提取数据。最初的具体兴趣是根据探索的方面对文章进行分类,特别是全身和放疗引起的并发症及其对住院的影响。第二个兴趣是检查研究的方法学质量,以适应固有的异质性。研究方案在PROSPERO(CRD42023462532)注册。
结果:在3289篇潜在文章中,选择了25篇纳入约3400万患者。在入选的文章中,有21项是队列研究,3项为随机对照试验(RCT),1项为横断面设计.在25项研究中,6项研究报告了≥10种并发症,而7项研究报告了6至10例的并发症。三项研究报告了单一并发症,5项研究报告了至少两种并发症,但少于6种,与其他选定研究相比,3项研究报告了更多的并发症(≥15).在报告的并发症中,中性粒细胞减少症,心脏并发症,呕吐,发烧,肾脏/肾损伤是最重要的。治疗后并发症的严重程度因治疗类型而异。研究表明,在选定的研究中,接受联合治疗的患者的治疗后并发症数量更高。20项研究(80%)报告了患者的总体住院率。七项研究显示,至少有一种并发症的癌症患者的住院率超过50%。此外,两项研究报告了由于重复治疗的并发症导致的高住院率(>90%).
结论:治疗后并发症的负担在不同的治疗模式中逐渐显现。联合治疗尤其与较高数量的治疗后并发症相关。持续的研究和治疗策略对于减轻癌症治疗和治疗程序的并发症至关重要。同时,医疗改革和加强对于解决癌症患者治疗相关并发症导致的住院率上升至关重要。
BACKGROUND: Hospitalisation resulting from complications of systemic therapy and radiotherapy places a substantial burden on the patient, society, and healthcare system. To formulate preventive strategies and enhance patient care, it is crucial to understand the connection between complications and the need for subsequent hospitalisation. This
review aimed to assess the existing literature on complications related to systemic and radiotherapy treatments for cancer, and their impact on hospitalisation rates.
METHODS: Data was obtained via electronic searches of the PubMed, Scopus, Embase and Google Scholar online databases to select relevant peer-reviewed papers for studies published between January 1, 2000, and August 30, 2023. We searched for a combination of keywords in electronic databases and used a standard form to extract data from each article. The initial specific interest was to categorise the articles based on the aspects explored, especially complications due to systemic and radiotherapy and their impact on hospitalisation. The second interest was to examine the methodological quality of studies to accommodate the inherent heterogeneity. The study protocol was registered with PROSPERO (CRD42023462532).
RESULTS: Of 3289 potential articles 25 were selected for inclusion with ~ 34 million patients. Among the selected articles 21 were cohort studies, three were randomised control trials (RCTs) and one study was cross-sectional design. Out of the 25 studies, 6 studies reported ≥ 10 complications, while 7 studies reported complications ranging from 6 to 10. Three studies reported on a single complication, 5 studies reported at least two complications but fewer than six, and 3 studies reported higher numbers of complications (≥ 15) compared with other selected studies. Among the reported complications, neutropenia, cardiac complications, vomiting, fever, and kidney/renal injury were the top-most. The severity of post-therapy complications varied depending on the type of therapy. Studies indicated that patients treated with combination therapy had a higher number of post-therapy complications across the selected studies. Twenty studies (80%) reported the overall rate of hospitalisation among patients. Seven studies revealed a hospitalisation rate of over 50% among cancer patients who had at least one complication. Furthermore, two studies reported a high hospitalisation rate (> 90%) attributed to therapy-repeated complications.
CONCLUSIONS: The burden of post-therapy complications is emerging across treatment modalities. Combination therapy is particularly associated with a higher number of post-therapy complications. Ongoing research and treatment strategies are imperative for mitigating the complications of cancer therapies and treatment procedures. Concurrently, healthcare reforms and enhancement are essential to address the elevated hospitalisation rates resulting from treatment-related complications in cancer patients.