安寧病房老年癌末病人14日內存活期之預測－依據病人的臨床特徵及實驗室檢查

Prediction of Mortality within 14 Days for Elderly Terminally Ill Cancer Patients by Clinical Characteristics and Laboratory Tests

高以信(Yee-Hsin Kao) ； 賴育民(Yu-Min Lai) ； 江瑞坤(Jui-Kun Chiang) ； 陳世琦(Shi-Chi Chen)

《台灣家庭醫學雜誌》 21卷1期 (2011/03) Pp. 15-26

https://doi.org/10.7023/TJFM.201103.0015

摘要

Background: The issue of survival time for elderly, terminally ill cancer patients is always a major concern for patients, families, and the hospice-care team. If we could provide accurate prognostic information, then patients could benefit from appropriate planning for end-of-life, and the patient's family from appropriate planning about their daily work. Physicians can optimize our care by avoiding futile treatment measures during the patient's dying stage.Objectives: Our aim was to analyze the different factors in predicting mortality within 2 weeks of hospice admission for elderly cancer patients.Methods: This retrospective study was conducted on elderly patients who were admitted to the hospital-based hospice ward during the period of November 2004 to May 2007. Data were collected by chart review and included demographic data, clinical characteristics, laboratory tests within 24 hours after admission, and the date of death.Results: Of 433 patients who were enrolled in the study, 187 died within 14 days after hospice admission and 246 patients died after more than 14 days. When we compared the 2 groups, we found that some factors were significant in the group who died within 14 days after admission. These included male gender; worse performance status (ECOG=3 or 4 vs. =1 or 2); primary cancer in the liver; higher values for WBC, BUN, creatinine, SGOT, total bilirubin, potassium, corrected calcium, and lower values for lymphocyte percentage and albumin. On logistic regression analysis, the significant factors for predicting death within 14 days after hospice admission in elderly, terminally ill cancer patients were male gender (p=0.002), worse performance status (p＜0.001), a greater number of metastases (p=0.020), liver as the primary cancer site (p=0.004), more WBCs (p=0.010) and higher BUN (p＜0.001). The accuracy of this model was 76.5% in this study.Conclusion: We therefore concluded that the death of elderly, terminally ill cancer patients could be predicted based on our protocol. Our study revealed significant prognostic factors to be male gender, performance status, number of metastatic sites involved, hepatocellular carcinoma, WBC, and BUN. As a result, we can deliver more appropriate and compassionate care to these patients and their families.

並列摘要

Background: The issue of survival time for elderly, terminally ill cancer patients is always a major concern for patients, families, and the hospice-care team. If we could provide accurate prognostic information, then patients could benefit from appropriate planning for end-of-life, and the patient's family from appropriate planning about their daily work. Physicians can optimize our care by avoiding futile treatment measures during the patient's dying stage.Objectives: Our aim was to analyze the different factors in predicting mortality within 2 weeks of hospice admission for elderly cancer patients.Methods: This retrospective study was conducted on elderly patients who were admitted to the hospital-based hospice ward during the period of November 2004 to May 2007. Data were collected by chart review and included demographic data, clinical characteristics, laboratory tests within 24 hours after admission, and the date of death.Results: Of 433 patients who were enrolled in the study, 187 died within 14 days after hospice admission and 246 patients died after more than 14 days. When we compared the 2 groups, we found that some factors were significant in the group who died within 14 days after admission. These included male gender; worse performance status (ECOG=3 or 4 vs. =1 or 2); primary cancer in the liver; higher values for WBC, BUN, creatinine, SGOT, total bilirubin, potassium, corrected calcium, and lower values for lymphocyte percentage and albumin. On logistic regression analysis, the significant factors for predicting death within 14 days after hospice admission in elderly, terminally ill cancer patients were male gender (p=0.002), worse performance status (p＜0.001), a greater number of metastases (p=0.020), liver as the primary cancer site (p=0.004), more WBCs (p=0.010) and higher BUN (p＜0.001). The accuracy of this model was 76.5% in this study.Conclusion: We therefore concluded that the death of elderly, terminally ill cancer patients could be predicted based on our protocol. Our study revealed significant prognostic factors to be male gender, performance status, number of metastatic sites involved, hepatocellular carcinoma, WBC, and BUN. As a result, we can deliver more appropriate and compassionate care to these patients and their families.

並列關鍵字

elderly ； terminally ill cancer ； prognostic factors ； hospice

參考文獻

Department of Household Registration Affairs M, Taiwan. Population by Age. In Edition 2009.

Department of Health EY, Taiwan, R.O.C. Taiwan Area Main Causes of Death, 2009. Taipei: Department of Health, Executive Yuan, Taiwan, R.O.C. In Edition 2009.

Department of Health EY, Taiwan, R.O.C.. Taiwan Area Main Causes of Death, 2007. Taipei: Department of Health, Executive Yuan, Taiwan, R.O.C. In Edition 2007.

Department of Health EY, Taiwan, R.O.C. No. of Deaths and Crude Death Rates from leading cancer Causes of Death by Age Group and Gender. In Edition 2007.

Abramson, N.,Melton, B.(2000).Leukocytosis: basics of clinical assessment.Am Fam Physician.62,2053-60.