早期姑息治疗对晚期癌症患者照顾者的影响：集群随机试验。

Impact of early palliative care on caregivers of patients with advanced cancer: cluster randomised trial.

机构信息

Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.

Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Canada.

出版信息

Ann Oncol. 2017 Jan 1;28(1):163-168. doi: 10.1093/annonc/mdw438.

DOI:10.1093/annonc/mdw438

PMID:27687308

Abstract

BACKGROUND

Early palliative care improves the quality of life (QoL) and satisfaction with care of patients with advanced cancer, but little is known about its effect on caregivers. Here, we report outcomes of caregiver satisfaction with care and QoL from a trial of early palliative care.

PATIENTS AND METHODS

Twenty-four medical oncology clinics were cluster-randomised, stratified by tumour site (lung, gastrointestinal, genitourinary, breast and gynaecological), to early palliative care team referral, or to standard oncology care with palliative care only as needed. Caregivers of patients with advanced cancer (clinical prognosis of 6-24 months, Eastern Cooperative Oncology Group 0-2) in both trial arms completed validated measures assessing satisfaction with care (FAMCARE-19) and QoL [SF-36v2 Health Survey; Caregiver QoL-Cancer (CQoL-C)], at baseline and monthly for 4 months. We used a multilevel linear random-intercept mixed-effect model to test whether there was improvement in the intervention group relative to the control group over 3 and 4 months.

RESULTS

A total of 182 caregivers completed baseline measures (94 intervention, 88 control); 151 caregivers (77 intervention, 74 control) completed at least one follow-up assessment. Satisfaction with care improved in the palliative intervention group compared with controls over 3 months (P = 0.007) and 4 months (P = 0.02). There was no significant improvement in the intervention group compared with controls for CQoL-C (3 months: P = 0.92, 4 months: P = 0.51), Physical Component Summary of the SF-36v2 Health Survey (3 months: P = 0.83, 4 months: P = 0.20), or Mental Component Summary of the SF-36v2 Health Survey (3 months: P = 0.87, 4 months: P = 0.60).

CONCLUSION

Early palliative care increased satisfaction with care in caregivers of patients with advanced cancer.

CLINICALTRIALS.GOV IDENTIFIER: NCT01248624.

摘要

背景

早期姑息治疗可提高晚期癌症患者的生活质量（QoL）和对治疗的满意度，但对于照顾者的影响却知之甚少。在此，我们报告了一项早期姑息治疗试验中照顾者对护理的满意度和 QoL 的结果。

患者和方法

24 个医学肿瘤学诊所采用集群随机化，按肿瘤部位（肺部、胃肠道、泌尿生殖系统、乳腺和妇科）分层，分为早期姑息治疗小组转诊组或标准肿瘤学治疗组，姑息治疗仅在需要时进行。在试验组中，患有晚期癌症（临床预后 6-24 个月，东部合作肿瘤学组 0-2）的患者的照顾者在基线和每月完成 4 个月的姑息治疗，完成了经过验证的评估护理满意度的措施（FAMCARE-19）和 QoL [SF-36v2 健康调查；照顾者 QoL-癌症（CQoL-C）]。我们使用多级线性随机截距混合效应模型来测试干预组相对于对照组在 3 个月和 4 个月时的改善情况。

结果

共有 182 名照顾者完成了基线评估（94 名干预组，88 名对照组）；151 名照顾者（77 名干预组，74 名对照组）完成了至少一次随访评估。与对照组相比，姑息治疗组在 3 个月（P=0.007）和 4 个月（P=0.02）时，对护理的满意度均有所提高。与对照组相比，干预组在 CQoL-C 方面（3 个月：P=0.92，4 个月：P=0.51）、SF-36v2 健康调查的生理成分综合评分（3 个月：P=0.83，4 个月：P=0.20）或 SF-36v2 健康调查的心理成分综合评分（3 个月：P=0.87，4 个月：P=0.60）均无显著改善。