目的:姑息治疗可以改善患有癌症的青少年和年轻人(AYA)的生活质量。然而,人们对AYA癌症患者姑息治疗的使用知之甚少。确定与姑息治疗相关的因素可以为改善AYA癌症患者姑息治疗的努力提供信息。
方法:使用2016-2019年全国住院患者样本的数据,这是美国住院的代表性样本,我们研究了因癌症和高住院死亡率风险的AYA住院患者的姑息治疗情况和相关特征.使用调查设计调整的双变量和多变量逻辑回归模型来检查患者和医院级别特征与姑息治疗的关联。
结果:在有高死亡风险的AYA癌症患者中,有10,979人住院,19.9%的人在2016年至2019年期间接受了姑息治疗服务。调整所有特性后,姑息治疗使用的独立预测因素如下:年龄较大(25-39岁vs.25-39年;赔率比[OR]1.31,95%置信区间[CI]1.15-1.49),西班牙裔/拉丁裔(vs.非西班牙裔白人;OR1.16,95%CI1.01-1.34),女性(vs.男性;OR1.27,95%CI1.14-1.41),公共保险(与私人保险;OR1.23,95%CI1.10-1.38),美国南部的医院位置(vs.东北部;OR0.78,95%CI0.66-0.94),和一家大医院(vs.小;或0.83,95%CI0.72-0.96)。
结论:不到20%的患有癌症和高死亡风险的AYAs患者接受了住院姑息治疗服务。需要进一步的研究来探索年轻年龄组姑息治疗利用率较低的原因。
OBJECTIVE: Palliative care can improve the quality of life of adolescents and young adults (AYA) with cancer. However, little is known about the utilization of palliative care among AYA cancer patients. Identifying factors associated with the utilization of palliative care could inform efforts to improve palliative care access among AYA patients living with cancer.
METHODS: Using data from the National Inpatient Sample 2016-2019, a representative sample of US hospitalizations, we examined palliative care encounters and associated characteristics among hospitalizations of AYA with cancer and high inpatient mortality risk. Survey design-adjusted bivariate and multivariable logistic regression models were used to examine associations of patient- and hospital-level characteristics with palliative care.
RESULTS: Of 10,979 hospitalizations by AYA cancer patients with high mortality risk, 19.9% received palliative care services between 2016 and 2019. After adjusting for all characteristics, independent predictors of palliative care use were as follows: older age (25-39 years old vs. 25-39 years; odds ratio [OR] 1.31, 95% confidence interval [CI] 1.15-1.49), Hispanic/Latinx (vs. non-Hispanic White; OR 1.16, 95% CI 1.01-1.34), female (vs. male; OR 1.27, 95% CI 1.14-1.41), public insurance (vs. private insurance; OR 1.23, 95% CI 1.10-1.38), hospital location in the US South (vs. Northeast; OR 0.78, 95% CI 0.66-0.94), and a large hospital (vs. small; OR 0.83, 95% CI 0.72-0.96).
CONCLUSIONS: Less than 20% of AYAs with cancer and high risk of mortality received inpatient palliative care services. Further research is needed to explore the reasons for lower palliative care utilization in the younger age groups.