| OBJECTIVEThe first part of this study, the treatment state of cancer patients during the last six months wasinvestigated,in order to realize the situation that how the end-stage cancer patients to get surgery, radiotherapy, chemotherapy and aggressive rescue, and the implementation of palliative and hospice care. The second partwas designed with the reason that we want to explore the related reasons which resulted to the current situation of treatments in end-stage cancer patients, mainly includes three questions:What problems existed in predicting cancer patients’survival time more accurately? What about the different views among patients, patients’families and medical staffs on death related issues, and their communication problems on the treatment of end-stage, and what about the actual implementation of palliative care basic drugs?Our purpose were:to find a simple and reliable expected survival index of end-stage cancer patients, to develop better palliative care and hospice information education, and to provide guidance for palliative care related personnel training.MATERIALS AND METHODSThe first part was a retrospective investigation about the last six month’s treatment of the patients before death, from January2010to July2010in generallCU and Cancer Center (55vs161cases),Tongji hospital of HUST.Theinvestigation items including:whether the patients accepted the surgical treatment during the last six months/3months/1month, whether accepted radiotherapy/chemotherapy during the last3months/1month12weeks, whether accepted the targeted therapy tracheal intubation/tube/electrical shock/chest compressions in the last day, whether accepted blood products/drainage tube placement/invasive examinationduring the last one month. Chi-square test was used to compare the differences between ICU and Cancer Center.In the second part the changes of lactate dehydrogenase (LDH) of216cases of cancer in their last6months was analysised.In addition, also289cancer center medical staffs, cancer patients and patients’families (1.07:1.08:l)were investigated. Investigation item Including:gender, age, marital status, nationality, class, cultural degree, family, home, family per capita income, religious beliefs, whether they are willing to talk about death topic, what’s their view on death and hospice care education information needs, etc. Descriptive statistical analysis, Wilcoxon rank sum test, regression analysis were used in data analysis. At last, the IAHPC drugs usage of cancer patients during their hospitalization were recorded from the electronic medical record system of Wuhan Tongji Hospital from2013July to August, in order to identify whether patients’characteristics had impact on the usage of IAHPC drugs.RESULTSThis study found that,1month before death, there was16.7%of cancer patients still treated with surgery,and20.8%of patients undergoing chemotherapy and4.2%of patients receiving radiotherapy. On the day of death, the proportion of patients with invasive rescue, such as endotracheal intubation and tracheotomy, the electric defibrillation and chest compressions, ICU (81.8%,1.8%,14.6%,76.4%) was significantly higher than Cancer Center (1.2%,0%,0%,39.1%).On his deathbed refused to have a rescue, chest compressions, and gave up the rescue, there were31.7%,19.9%and6.8%respectively in Cancer Center and in ICU were only3.6%,5.5%and5.5%respectively. The proportion of patients whoaccepted red blood cells, white blood cells, platelets, cold precipitation (except plasma albumin), as well as various puncture and cavity mirror examination,ICUwas significantly higher than Cancer Center.The second part showed that for the216cancer patientsin the first part, more close to death, higher the patients’ LDH leveLAverage LDH of the patient inl week and3days before death were600.75U/L and941.64U/L respectively, much higher than normal. LDH has certain value forpredicting prospective survival time, but it often been overlooked.In addition, survey showed that26.64%of respondents (11.22%of the medical staff,27.27%of the patients,42.39%of the patients’ families) mind talking about death related issues, half of them (54.55%) can accept "living wills", but19.48%cannot understand its meaning, in "the attitude of dying patients receiving treatment", majority (70.13%) think positive treatment method should be adopted. Whether respondents mind to talk about death related issues has a correlation with "talking about death situation","culture" and "age"(regression coefficients were0.9846,0.9846, and0.3512). The respondents who donot mind talking about death related problems mainly were "he attitude of treatment for the dying person"(P<0.0001),"the choice of the ways of death"(P=0.008),"death location choice"(P=0.0059),"is it necessary to death education"(P<0.0001),"willing to accept death education"(P<0.0001),"the hospital environment can meet the needs of the dying patient’s body and mind"(P<0.0001),"it is necessary to carry out the hospital palliative care"(P<0.0007). Finally, the basic drug investigation and analysis showed that palliative care cancer patients with mild pain used most was diclofenac (10.82%), moderately severe pain was oxycodone (12.88%), followed by morphine and fentanyl.Patients with neuropathy pain used most were gabapentin.Megestrol acetate, dexamethasone and hydrocortisone were used to improve anorexia. In order to relieve nausea and vomiting, most classes of drug were used, with the highest percentage of dexamethasone, diphenhydramine and haloperidol (38.9%,36.58%and33.56%respectively). Nervous system drugs were seldom used, such as diazepam (4.38%) and lorazepam (32.6%). No use of respiratory symptoms drugs. Patients’ gender showed some influence on nervous system drugs’ usage, also with age on digestive system drugs’usage, the length of hospitalization on all the essential medicines’ usage.CONCLUSIONSThere were still many problems exist in the treatments of end-stage cancer patients, such as surgery, radiotherapy, chemotherapy, and so on,which did not have enough benefits for the patients. On his deathbed to accept invasive rescue and too much intravenous fluidswould make cancer patients did not get the best quality of life, failing to benefit from palliative and hospice care, all of those withmany reasons. This study suggests althoughlacking unity expected survival index for end-stage cancer patients, but LDH is one ofsimple and feasible evaluation index, is of great significance in guidingtreatment decisionsfor patients with end-stage.On the cognitive problems, cancer patients and their families, medical staff avoided death related problems, lacked communication and hospice care information, which were the obstacles of the implementationof palliative and hospice care. In addition, theapplication of the basic drugs is also a problem which needs to be settled.All ofabove were treat breakthrough pointsto improve the present situation of treatments in end-stage cancer patients. |
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