背景:癌症是挪威的主要死亡原因。在这项全国性的研究中,我们描述了死于癌症的患者在生命的最后一年住院和治疗的数量和原因,以及与年龄和社会经济地位(SES)的联系。
方法:从涵盖2010-2014年的全国注册中,我们确定了所有在死亡前12-60个月被诊断患有癌症并患有癌症的患者作为其报告的死亡原因。我们检查了过夜住院的次数,入院原因,和治疗(化疗,放射治疗,外科手术)在生命的最后一年由个人(年龄,性别,合并症),癌症(类型,舞台,诊断后几个月),和社会经济变量(共同居住状态,收入,education).
结果:分析样本包括17,669例患者;8,247例(47%)为女性,平均年龄为71.7岁(标准差13.7).诊断时,31%有转移性疾病,而29%的人有中等或高的共病负担。总之,94%的人在最后一年住院,82%至少两次,33%是6倍或更多。患者住院时间中位数为23天(四分位距11-41),总共有38%的人死在那里。年龄更小,膀胱癌和卵巢癌,不是独自生活,较高的收入与≥6次住院相关.癌症相关诊断是住院的主要原因(65%),其次是感染(11%)。约51%的患者有≥1次化疗发作,根据患者年龄和SES有很大差异;年轻的患者,没有独自生活,受过高等教育,高收入接受了更多的化疗。接受放射治疗的比例为15%,并随着年龄的增长而下降,根据SES特征的变化很小。在12940名癌症患者中,手术是主要的治疗方式,在生命的最后一年中,只有835例(6%)接受了原发肿瘤的外科手术。
结论:大多数死于癌症的患者在生命的最后一年多次住院。住院和治疗随着年龄的增长而下降。独居和低收入与住院次数减少和化疗治疗减少有关。这是否表明不同群体的过度或不足,值得进一步探索。
Cancer is the leading cause of death in Norway. In this nationwide study we describe the number and causes of hospital admissions and treatment in the final year of life for patients who died of cancer, as well as the associations to age and socioeconomic status (SES).
From nationwide registries covering 2010-2014, we identified all patients who were diagnosed with cancer 12-60 months before death and had cancer as their reported cause of death. We examined the number of overnight hospital stays, causes of admission, and treatment (chemotherapy, radiotherapy, surgical procedures) offered during the last year of life by individual (age, sex, comorbidity), cancer (type, stage, months since diagnosis), and socioeconomic variables (co-residential status, income, education).
The analytical sample included 17,669 patients; 8,247 (47%) were female, mean age was 71.7 years (standard deviation 13.7). At diagnosis, 31% had metastatic disease, while 29% had an intermediate or high comorbidity burden. Altogether, 94% were hospitalized during their final year, 82% at least twice, and 33% six times or more. Patients spent a median of 23 days in hospital (interquartile range 11-41), and altogether 38% died there. Younger age, bladder and ovarian cancer, not living alone, and higher income were associated with having ≥6 hospitalizations. Cancer-related diagnoses were the main causes of hospitalizations (65%), followed by infections (11%). Around 51% had ≥1 chemotherapy episode, with large variations according to patient age and SES; patients who were younger, did not live alone, had high education, and high income received more chemotherapy. Radiotherapy was received by 15% and declined with age, and the variation according to SES characteristics was minor. Of the 12,940 patients with a cancer type where surgery is a main treatment modality, only 835 (6%) underwent surgical procedures for their primary tumor in the last year of life.
Most patients who die of cancer are hospitalized multiple times during the last year of life. Hospitalizations and treatment decline with advancing age. Living alone and having low income is associated with fewer hospitalizations and less chemotherapy treatment. Whether this indicates over- or undertreatment across various groups warrants further exploration.