系统性抗癌疗法和非常先进的固体瘤患者的整体存活率
Maureen E Canavan1, Xiaoliang Wang2, Mustafa S Ascha2
1Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, Connecticut.
JAMA oncology
|May 16, 2024
概括
通过NQF 0210测量寿命末期化疗的更高率,并没有改善晚期癌症患者的生存率. 这表明需要改进质量指标,并专注于无用的治疗识别和沟通技巧.
科学领域:
- 在瘤学瘤学.
- 医疗保健服务研究 医疗服务研究
- 抚慰性护理是一种缓解性护理.
背景情况:
- 国家质量论坛 (NQF) 开发了0210指标,以减少临终期的化疗.
- 批评人士认为,NQF 0210并不涵盖所有可能受益于优化生命终端护理的患者.
- 本研究研究了实践水平NQF 0210率与晚期癌症患者的整体存活率之间的关系.
研究的目的:
- 为了确定是否患有转移性癌症的患者在生命结束时在实践中接受更高系统抗癌治疗率的治疗,经历了更长的生存期.
- 评估实践水平NQF 0210率与广泛的晚期癌症患者群体的整体存活率之间的关联.
主要方法:
- 全国一项以人口为基础的队列研究利用了Flatiron Health (2015-2019) 的非识别电子健康记录.
- 包括有6种常见的晚期癌症 (乳腺癌,结肠直肠癌,非小细胞癌,胰腺癌,细胞癌,尿路细胞癌) 的成年患者.
- 实践被按NQF 0210率分为五分之一层;使用多变量Cox模型与邦费罗尼校正比较整体存活率.
主要成果:
- 该研究分析了144个实践中的78,446名患者;常见的癌症包括NSCLC (43.6%) 和结直肠 (20.1%).
- 实践水平的NQF 0210率因癌症类型和五分位数而异.
- 在NQF 0210比率最高和最低的实践中治疗的患者之间,在总生存率上没有发现统计学上显著的差异.
结论:
- 在实践水平上,较高的NQF 0210率与转移性或晚期癌症患者的生存率改善无关.
- 未来的努力应集中在瘤学家识别无用的疗法,加强护理目标沟通,并将支付激励措施与质量终身护理相协调.
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