背景:在转移性癌症患者的治疗过程中及时纳入姑息治疗(PC)可以改善症状管理和生活质量。老年与癌症患者PC使用率较低有关。患有转移性乳腺癌(MBC)的老年患者接受PC的频率未知。这项研究的目的是使用国家癌症数据库(NCDB)来描述75岁以上的MBC老年人使用PC的国家模式。
方法:从NCDB中发现了2010年至2019年年龄≥75岁的诊断为MBC的女性。NCDB将PC定义为任何手术,辐射,全身治疗,和/或非治愈性疼痛管理。使用多变量逻辑回归模型来评估PC接收与研究协变量之间的关联。
结果:在最终分析中包括的17,325名合格参与者中,75-79岁的占39.4%,80-84岁的占30.1%,≥85岁的占30.4%。总的来说,22.1%(N=3824)的患者使用PC,其中14.3%接受疼痛管理,而其余的人接受了姑息性意图手术,辐射,和/或全身治疗。西班牙裔患者不太可能接受zzPC(AOR:0.62,95%CI:0.48-0.79),p<0.001)。在总人口中,PC的使用量从2010年的19.2%增加到2019年的25.3%,尽管这主要是由于75-79岁年龄组的统计显着增加(19.9%到28.1%,p=0.001)。
结论:在来自NCDB的该患者人群中,我们观察到,在过去十年中,MBC老年人的PC利用率有所增加,尽管在85岁及以上的患者中增幅最低。需要进一步探索患有癌症的老年人的PC障碍。
BACKGROUND: Timely incorporation of palliative care (PC) during treatment of patients with metastatic cancers can improve symptom management and quality of life. Older age has been associated with lower PC use in patients with cancer. The frequency by which older patients with metastatic breast cancer (MBC) receive PC is unknown. The goal of this study was to use the National Cancer Database (NCDB) to describe national patterns in PC use in older adults over 75 years of age with MBC.
METHODS: Females with a diagnosis of MBC at age ≥ 75 years from 2010 to 2019 were identified from the NCDB. The NCDB defined PC as any surgery, radiation, systemic therapy, and/or pain management that was administered with noncurative intent. Multivariable logistic regression models were performed to assess associations between PC receipt and study covariates.
RESULTS: Of 17,325 eligible participants included in the final analysis, 39.4% were 75-79, 30.1% 80-84, and 30.4% ≥ 85 years of age. Overall, 22.1% (N = 3824) of patients utilized PC, of whom 14.3% received pain management, while the remainder received palliative intent surgery, radiation, and/or systemic therapy. Patients who were Hispanic were less likely to receive zzPC (AOR: 0.62, 95% CI: 0.48-0.79), p < 0.001). In the overall population, the use of PC increased from 19.2% in 2010 to 25.3% in 2019, though this was primarily driven by the statistically significant increase in the 75-79 age group (19.9% to 28.1%, p = 0.001).
CONCLUSIONS: In this patient population from the NCDB, we observed an increase in PC utilization over the last decade in older adults with MBC, though the increase was lowest in patients who were 85 years and older. Barriers to PC in older adults with cancer need to be further explored.