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Matthias Knefel PhD Elisabeth L. Zeilinger PhD Simone Lubowitzki PhD Katharina Krammer MSc Matthias Unseld MD Rupert Bartsch MD Thorsten Fuereder MD Ulrich Jäger MD Barbara Kiesewetter MD Maria Krauth MD Markus Raderer MD Philipp B. Staber MD Peter Valent MD Alexander Gaiger MD 《Cancer》2023,129(21):3466-3475
Background
Survival in cancer patients is associated with a multitude of biological, social, and psychological factors. Although it is well established that all these factors add to overall mortality, it is not well understood how the predictive power of these parameters changes in a comprehensive model and over time.Methods
Patients who attended the authors’ outpatient clinic were invited to participate. The authors followed 5180 mixed cancer patients (51.1% female; mean age, 59.1 years [SD = 13.8]) for up to 16 years and analyzed biological (age, sex, cancer site, anemia), psychological (anxiety, depression), and social variables (marital status, education, employment status) potentially predicting overall survival in a Cox proportional hazards model.Results
The median survival time for the entire sample was 4.3 years (95% confidence interval, 4.0–4.7). The overall survival probabilities for 1 and 10 years were 76.8% and 38.0%, respectively. Following an empirical approach, the authors split the time interval into five periods: acute, subacute, short-term, medium-term, and long-term. A complex pattern of variables predicted overall survival differently in the five periods. Biological parameters were important throughout most of the time, social parameters were either time-independent predictors or tended to be more important in the longer term. Of the psychological parameters, only depression was a significant predictor and lost its predictive power in the long-term.Conclusions
The findings of this study allow the development of comprehensive patient-specific models of risk and resilience factors addressing biopsychosocial needs of cancer patients, paving the way for a personalized treatment plan that goes beyond biomedical cancer care. 相似文献14.
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Many patients with terminal cancer wish to die at home and general practitioners in the United Kingdom have a critical role in providing this care. However, it has been suggested general practitioners lack confidence in end-of-life care. It is important to explore with general practitioners their experience and perspectives including feelings of confidence delivering end-of-life care to people with cancer. The aim of this study was to explore general practitioners experiences of providing end-of-life care for people with cancer in the home setting and their perceptions of confidence in this role as well as understanding implications this has on policy design. A qualitative study design was employed using semi-structured interviews and analysed using thematic analysis. Nineteen general practitioners from London were purposively sampled from eight general practices and a primary care university department in 2018–2019, supplemented with snowballing methods. Five main themes were constructed: (a) the subjective nature of defining palliative and end-of-life care; (b) importance of communication and managing expectations; (c) complexity in prescribing; (d) challenging nature of delivering end-of-life care; (e) the unclear role of primary care in palliative care. General practitioners viewed end-of-life care as challenging; specific difficulties surrounded communication and prescribing. These challenges coupled with a poorly defined role created a spread in perceived confidence. Experience and exposure were seen as enabling confidence. Specialist palliative care service expansion had important implications on deskilling of essential competencies and reducing confidence levels in general practitioners. This feeds into a complex cycle of causation, leading to further delegation of care. 相似文献
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Tomoe Koizumi PhD Yodo Sugishita MD PhD Yuki Suzuki-Takahashi MD PhD Kazuko Nara MA Tomoko Miyagawa MA Misako Nakajima MA Kouhei Sugimoto MD PhD Manabu Futamura MD PhD Tatsuro Furui MD PhD Yasushi Takai MD PhD Hiroshi Matsumoto MD PhD Hideko Yamauchi MD Shinji Ohno MD PhD Akemi Kataoka MD PhD Kiyotaka Kawai MD PhD Eisuke Fukuma MD PhD Hiroko Nogi MD PhD Koichiro Tsugawa MD PhD Nao Suzuki MD PhD 《Cancer》2023,129(16):2568-2580
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