終末期がん患者の予後ががん治療医の予後予測よりも短い要因について
【目的】終末期がん患者の生存期間ががん治療医の経験に基づく予後予測よりも短い患者側の要因，および死亡までの経過との関連を検討する．【方法】KKR札幌医療センター緩和ケア病棟に予後1〜3カ月として紹介され，その後3カ月以内に死亡退院した終末期がん患者を対象に，後方視的検討を行った．【結果】対象患者249例のうち，実際の生存期間が1カ月未満であった患者は102例（OS1, 41％），1カ月以上3カ月以内の患者は147例（OS1–3, 59％）であった．Japan Coma Scale II以上の意識障害，経口摂取量数口以下を呈する患者がOS1–3に比べOS1で有意に多かった．2日以内で死に至る急な...
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| Published in | Palliative Care Research Vol. 16; no. 4; pp. 307 - 314 |
|---|---|
| Main Authors | , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本緩和医療学会
2021
|
| Subjects | |
| Online Access | Get full text |
| ISSN | 1880-5302 |
| DOI | 10.2512/jspm.16.307 |
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| Abstract | 【目的】終末期がん患者の生存期間ががん治療医の経験に基づく予後予測よりも短い患者側の要因，および死亡までの経過との関連を検討する．【方法】KKR札幌医療センター緩和ケア病棟に予後1〜3カ月として紹介され，その後3カ月以内に死亡退院した終末期がん患者を対象に，後方視的検討を行った．【結果】対象患者249例のうち，実際の生存期間が1カ月未満であった患者は102例（OS1, 41％），1カ月以上3カ月以内の患者は147例（OS1–3, 59％）であった．Japan Coma Scale II以上の意識障害，経口摂取量数口以下を呈する患者がOS1–3に比べOS1で有意に多かった．2日以内で死に至る急な容態変化による死亡はOS1で有意に多かった．【結論】上記要因を持つ患者の生存期間は予測予後より短い可能性があるが，予後の不正確性に与える医師側の要因を検討する必要がある． |
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| AbstractList | 【目的】終末期がん患者の生存期間ががん治療医の経験に基づく予後予測よりも短い患者側の要因，および死亡までの経過との関連を検討する．【方法】KKR札幌医療センター緩和ケア病棟に予後1〜3カ月として紹介され，その後3カ月以内に死亡退院した終末期がん患者を対象に，後方視的検討を行った．【結果】対象患者249例のうち，実際の生存期間が1カ月未満であった患者は102例（OS1, 41％），1カ月以上3カ月以内の患者は147例（OS1–3, 59％）であった．Japan Coma Scale II以上の意識障害，経口摂取量数口以下を呈する患者がOS1–3に比べOS1で有意に多かった．2日以内で死に至る急な容態変化による死亡はOS1で有意に多かった．【結論】上記要因を持つ患者の生存期間は予測予後より短い可能性があるが，予後の不正確性に与える医師側の要因を検討する必要がある． |
| Author | 田中, 輝明 大場, 洋子 横田, 勲 瀧川, 千鶴子 佐藤, 雅子 |
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| References | 19) Selby D, Chakraborty A, Lilien T, et al. Clinician accuracy when estimating survival duration: the role of the patient’s performance status and time-based prognostic categories. J Pain Symptom Manage 2011; 42: 578-88. 2) 厚生労働省．平成29年度人生の最終段階における医療に関する意識調査報告書．https://www.mhlw.go.jp/toukei/list/dl/saisyuiryo_a_h29.pdf （2021年10月10日アクセス） 7) Christakis NA, Lamont EB. Extent and determinants of error in doctors’ prognoses in terminally ill patients: prospective cohort study. BMJ 2000; 320: 469-72. 5) Weckmann MT. The role of the family physician in the referral and management of hospice patients. Am Fam Physician 2008; 77: 807-12. 15) White N, Reid F, Harris A, et al. A Systematic Review of Predictions of Survival in Palliative Care: How Accurate Are Clinicians and Who Are the Experts? PLoS One 2016; 11: e0161407. 9) Hui D. Unexpected death in palliative care: what to expect when you are not expecting. Curr Opin Support Palliat Care 2015; 9: 369-74. 16) Muers MF, Shevlin P, Brown J. Prognosis in lung cancer: physicians’ opinions compared with outcome and a predictive model. Thorax 1996; 51: 894-902. 22) Maltoni M, Caraceni A, Brunelli C, et al. Prognostic factors in advanced cancer patients: evidence-based clinical recommendations—a study by the Steering Committee of the European Association for Palliative Care. J Clin Oncol 2005; 23: 6240-8. 20) Gwilliam B, Keeley V, Todd C, et al. Prognosticating in patients with advanced cancer--observational study comparing the accuracy of clinicians’ and patients’ estimates of survival. Ann Oncol 2013; 24: 482-8. 18) Hølmebakk T, Solbakken A, Mala T, et al. Clinical prediction of survival by surgeons for patients with incurable abdominal malignancy. Eur J Surg Oncol 2011; 37: 571-5. 6) Mulville AK, Widick NN, Makani NS. Timely Referral to Hospice Care for Oncology Patients: A Retrospective Review. Am J Hosp Palliat Care 2019; 36: 466-71. 8) Cheon S, Agarwal A, Popovic M, et al. The accuracy of clinicians’ predictions of survival in advanced cancer: a review. Ann Palliat Med 2016; 5: 22-9. 10) Morita T, Tsunoda J, Inoue S, et al. The Palliative Prognostic Index: a scoring system for survival prediction of terminally ill cancer patients. Support Care Cancer 1999; 7: 128-33. 25) Scott K. Incidence of sudden, unexpected death in a specialist palliative care inpatient setting. Palliat Med 2010; 24: 449-50. 1) 厚生労働省．令和2年厚生労働省告示第58号：基本診療料の施設基準等の一部を改正する件“緩和ケア病棟入院料の施設基準等”. 21) Tseng YD, Krishnan MS, Sullivan AJ, et al. How radiation oncologists evaluate and incorporate life expectancy estimates into the treatment of palliative cancer patients: a survey-based study. Int J Radiat Oncol Biol Phys 2013; 87: 471-8. 4) Myers J. Improving the quality of end-of-life discussions. Curr Opin Support Palliat Care 2015; 9: 72-6. 11) Pirovano M, Maltoni M, Nanni O, et al. A new palliative prognostic score: a first step for the staging of terminally ill cancer patients. Italian Multicenter and Study Group on Palliative Care. J Pain Symptom Manage 1999; 17: 231-9. 12) 厚生労働省．平成3年11月18日老健第102-2号厚生省大臣官房老人保健福祉部長通知．https://www.mhlw.go.jp/web/t_doc?dataId=00ta4156&dataType=1&pageNo=3 （2021年10月10日アクセス）. 13) 大浦武彦，堀田由浩編著．日本人の褥瘡危険要因「OHスケール」による褥瘡予防．日総研出版，愛知，2005; 16-63. 17) Kao SC, Butow P, Bray V, et al. Patient and oncologist estimates of survival in advanced cancer patients. Psychooncology 2011; 20: 213-8. 24) Bruera S, Chisholm G, Dos Santos R, et al. Frequency and factors associated with unexpected death in an acute palliative care unit: expect the unexpected. J Pain Symptom Manage 2015; 49: 822-7. 23) Schag CC, Heinrich RL, Ganz PA. Karnofsky performance status revisited: reliability, validity, and guidelines. J Clin Oncol 1984; 2: 187-93. 3) Seow H, Barbera L, Sutradhar R, et al. Trajectory of performance status and symptom scores for patients with cancer during the last six months of life. J Clin Oncol 2011; 29: 1151-8. 14) Wilcock A, Crosby V. Hospices and CPR guidelines. Sudden and unexpected death in a palliative care unit. BMJ 2009; 338: b2343. |
| References_xml | – reference: 10) Morita T, Tsunoda J, Inoue S, et al. The Palliative Prognostic Index: a scoring system for survival prediction of terminally ill cancer patients. Support Care Cancer 1999; 7: 128-33. – reference: 8) Cheon S, Agarwal A, Popovic M, et al. The accuracy of clinicians’ predictions of survival in advanced cancer: a review. Ann Palliat Med 2016; 5: 22-9. – reference: 15) White N, Reid F, Harris A, et al. A Systematic Review of Predictions of Survival in Palliative Care: How Accurate Are Clinicians and Who Are the Experts? PLoS One 2016; 11: e0161407. – reference: 14) Wilcock A, Crosby V. Hospices and CPR guidelines. Sudden and unexpected death in a palliative care unit. BMJ 2009; 338: b2343. – reference: 9) Hui D. Unexpected death in palliative care: what to expect when you are not expecting. Curr Opin Support Palliat Care 2015; 9: 369-74. – reference: 25) Scott K. Incidence of sudden, unexpected death in a specialist palliative care inpatient setting. Palliat Med 2010; 24: 449-50. – reference: 23) Schag CC, Heinrich RL, Ganz PA. Karnofsky performance status revisited: reliability, validity, and guidelines. J Clin Oncol 1984; 2: 187-93. – reference: 5) Weckmann MT. The role of the family physician in the referral and management of hospice patients. Am Fam Physician 2008; 77: 807-12. – reference: 1) 厚生労働省．令和2年厚生労働省告示第58号：基本診療料の施設基準等の一部を改正する件“緩和ケア病棟入院料の施設基準等”. – reference: 21) Tseng YD, Krishnan MS, Sullivan AJ, et al. How radiation oncologists evaluate and incorporate life expectancy estimates into the treatment of palliative cancer patients: a survey-based study. Int J Radiat Oncol Biol Phys 2013; 87: 471-8. – reference: 19) Selby D, Chakraborty A, Lilien T, et al. Clinician accuracy when estimating survival duration: the role of the patient’s performance status and time-based prognostic categories. J Pain Symptom Manage 2011; 42: 578-88. – reference: 6) Mulville AK, Widick NN, Makani NS. Timely Referral to Hospice Care for Oncology Patients: A Retrospective Review. Am J Hosp Palliat Care 2019; 36: 466-71. – reference: 13) 大浦武彦，堀田由浩編著．日本人の褥瘡危険要因「OHスケール」による褥瘡予防．日総研出版，愛知，2005; 16-63. – reference: 17) Kao SC, Butow P, Bray V, et al. Patient and oncologist estimates of survival in advanced cancer patients. Psychooncology 2011; 20: 213-8. – reference: 3) Seow H, Barbera L, Sutradhar R, et al. Trajectory of performance status and symptom scores for patients with cancer during the last six months of life. J Clin Oncol 2011; 29: 1151-8. – reference: 18) Hølmebakk T, Solbakken A, Mala T, et al. Clinical prediction of survival by surgeons for patients with incurable abdominal malignancy. Eur J Surg Oncol 2011; 37: 571-5. – reference: 24) Bruera S, Chisholm G, Dos Santos R, et al. Frequency and factors associated with unexpected death in an acute palliative care unit: expect the unexpected. J Pain Symptom Manage 2015; 49: 822-7. – reference: 16) Muers MF, Shevlin P, Brown J. Prognosis in lung cancer: physicians’ opinions compared with outcome and a predictive model. Thorax 1996; 51: 894-902. – reference: 2) 厚生労働省．平成29年度人生の最終段階における医療に関する意識調査報告書．https://www.mhlw.go.jp/toukei/list/dl/saisyuiryo_a_h29.pdf （2021年10月10日アクセス）． – reference: 20) Gwilliam B, Keeley V, Todd C, et al. Prognosticating in patients with advanced cancer--observational study comparing the accuracy of clinicians’ and patients’ estimates of survival. Ann Oncol 2013; 24: 482-8. – reference: 11) Pirovano M, Maltoni M, Nanni O, et al. A new palliative prognostic score: a first step for the staging of terminally ill cancer patients. Italian Multicenter and Study Group on Palliative Care. J Pain Symptom Manage 1999; 17: 231-9. – reference: 7) Christakis NA, Lamont EB. Extent and determinants of error in doctors’ prognoses in terminally ill patients: prospective cohort study. BMJ 2000; 320: 469-72. – reference: 12) 厚生労働省．平成3年11月18日老健第102-2号厚生省大臣官房老人保健福祉部長通知．https://www.mhlw.go.jp/web/t_doc?dataId=00ta4156&dataType=1&pageNo=3 （2021年10月10日アクセス）. – reference: 22) Maltoni M, Caraceni A, Brunelli C, et al. Prognostic factors in advanced cancer patients: evidence-based clinical recommendations—a study by the Steering Committee of the European Association for Palliative Care. J Clin Oncol 2005; 23: 6240-8. – reference: 4) Myers J. Improving the quality of end-of-life discussions. Curr Opin Support Palliat Care 2015; 9: 72-6. |
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| Title | 終末期がん患者の予後ががん治療医の予後予測よりも短い要因について |
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