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進行がん患者の早期緩和ケア:クラスターランダム化制御試験

Camilla Zimmermann¹, Nadia Swami², Monika Krzyzanowska³

¹Division of Medical Oncology and Haematology, Department of Medicine, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Department of Psychosocial Oncology and Palliative Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada; Campbell Family Cancer Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.

Lancet (London, England)

|February 25, 2014

まとめ

早期の緩和ケアにより,進行がん患者の生活の質と満足度が向上しました. 3ヵ月目には有意ではないが,4ヵ月目には利益が見られ,統合を支えた.

科学分野:

腫瘍学腫瘍学
緩和ケアとは,緩和ケアです.
生活の質の研究生活の質の研究

背景:

進行がんの患者は,生活の質の低下を経験し,特に終末期に近づいている.
緩和医療の早期統合は,これらの生活の質の低下を緩和することを目的としています.

研究の目的:

進行がん患者の生活の質に対する早期の緩和ケアコンサルティングの影響を評価する.
症状の重症度,ケアに対する満足度,医療との相互作用に関する問題を評価する.

主な方法:

24の腫瘍学診療所を含むクラスターランダム化試験で,緩和ケアチームと標準ケアを比較した.
進行がん (ECOG 0-2,予後6~24ヶ月) の患者は,4ヶ月間毎月評価されました.
生活の質 (FACIT-Sp, QUAL-E),症状 (ESAS),満足度 (FAMCARE-P16) および医療相互作用 (CARES-MIS) は,主および二次的アウトカムでした.

主要な成果:

4ヶ月で,早期の緩和ケアグループは,終末期の生活の質 (QUAL-E) と満足度 (FAMCARE-P16) で有意な改善を好みました.
プライマリエンドポイント (3ヶ月後のFACIT-Sp) は非有意であったが,トレンドは介入グループに好意的であった.
症状の重症度 (ESAS) と医学的相互作用の問題 (CARES-MIS) は3ヶ月で有意な違いを示さなかったが,4ヶ月で改善した.

結論:

早期の緩和医療は,進行がん患者にとって有望な利点を示し,全体的な幸福感とケア満足度を高めています.
非有意なプライマリエンドポイントにもかかわらず,この研究は,病気の軌道の初期に緩和ケアサービスを統合することを支持しています.

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