Journal of Hospice and Palliative Care

  • 제21권3호
  • /
  • Pages.75-83
  • /
  • 2018
  • /
  • 2765-3072(pISSN)
  • /
  • 2765-3080(eISSN)
한국호스피스완화의료학회 (Korean Society for Hospice and Palliative Care)
권호 표지
DOI QR코드

DOI QR Code

입원 초기 지표를 통한 호스피스 환자의 퇴원 형태 예측

Prediction of Patient Discharge Status Based on Indicators on Admission

  • 정성인 (부산대학교병원 가정의학과) ;
  • 이승훈 (부산대학교병원 가정의학과) ;
  • 김윤진 (부산대학교병원 가정의학과) ;
  • 이상엽 (부산대학교 의과대학 의학 교육실) ;
  • 이정규 (부산대학교병원 가정의학과) ;
  • 이유현 (부산대학교병원 가정의학과) ;
  • 조영혜 (부산대학교 의과대학 가정의학교실) ;
  • 탁영진 (부산대학교병원 가정의학과) ;
  • 황혜림 (부산대학교병원 가정의학과) ;
  • 박은주 (양산부산대학교병원 가정의학과) ;
  • 김경미 (부산대학교병원 가정의학과)
  • Chung, Sung-In (Department of Family Medicine, Pusan National University Hospital) ;
  • Lee, Seung Hun (Department of Family Medicine, Pusan National University Hospital) ;
  • Kim, Yun-Jin (Department of Family Medicine, Pusan National University Hospital) ;
  • Lee, Sang-Yeoup (Department of Medical Education, Pusan National University School of Medicine) ;
  • Lee, Jeong-Gyu (Department of Family Medicine, Pusan National University Hospital) ;
  • Yi, Yu-Hyeon (Department of Family Medicine, Pusan National University Hospital) ;
  • Cho, Young-Hye (Department of Family Medicine, Pusan National University School of Medicine) ;
  • Tak, Young-Jin (Department of Family Medicine, Pusan National University Hospital) ;
  • Hwang, Hye-Rim (Department of Family Medicine, Pusan National University Hospital) ;
  • Park, Eun-Ju (Department of Family Medicine, Pusan National University Yangsan Hospital) ;
  • Kim, Kyung-Mi (Department of Family Medicine, Pusan National University Hospital)
  • 투고 : 2018.05.10
  • 심사 : 2018.06.26
  • 발행 : 2018.09.01
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

목적: 호스피스 완화의료에서 환자의 기대 여명 예측뿐 아니라 퇴원형태를 예측하여 적절한 치료를 제공할 필요가 있다. 이번 연구에서는 입원 초기 환자의 퇴원 형태 예측에 유의한 요소들을 알아보고 효율적인 완화의료의 방향에 대해 제시하고자 한다. 방법: 2016년 4월 1일부터 2017년 12월 31일까지 P병원 호스피스 병동에 입원한 말기암환자 568명 중 377명을 대상으로 하였으며 입원 시 사정한 환자의 수행 지수, 증상 및 징후, 사회 경제적 상태와 혈액검사 자료를 바탕으로 연구를 진행하였다. 결과: 입원 당시 높은 수행지수, 양호한 증상 및 징후, 정상에 가까운 혈액검사 수치를 보일 때 생존 퇴원할 가능성이 높았다. 결론: 환자의 퇴원형태 예측에 ECOG, KPS, Global health, Mental status와 같은 수행지수, dyspnea, anorexia, dysphagia, fatigue와 같은 증상 및 징후, CBC, LFT, BUN, CRP 혈액검사 수치가 유의한 지표임을 확인하였다.

Purpose: To provide effective palliative care, it is important to predict not only patients' life expectancy but their discharge status at a time of inpatient admission to a hospice care facility. This study was aimed to identify meaningful life expectancy indicators that can be used to predict patients' discharge status on admission to the facility. Methods: Among 568 patients who were admitted to the hospice ward of P hospital from April 1, 2016 through December 31, 2017, 377 terminal cancer patients were selected. This retrospective cohort study was performed by using performance status, symptoms and signs, socioeconomic status, laboratory findings on admission. Results: Alive discharge was associated with a good performance status that was measured with the Karnofsky and Eastern Cooperative Oncology Group (ECOG) scales and the Global health and Mental status. Less anorexia, dyspnea, dysphagia and fatigue were also associated with symptoms and signs. Associated laboratory findings were close to normal Complete Blood Cell (CBC) count, Liver Function Test (LFT) and Blood Urea Nitrogen (BUN). Conclusion: Our findings suggest that Karnofsky Performance Status (KPS), ECOG, Global health, Mental status, anorexia, dyspnea, dysphagia, fatigue, CBC, LFT, BUN are meaningful indicators when predicting discharge status for inpatients. Further investigation is warranted.

키워드

참고문헌

  1. Hospice and Palliative Care [Internet]. Goyang: Hospice and Palliative Care; c2015. [cited 2018 Jan 23]. Available from: http://hospice.cancer.go.kr/home//contentsInfo.do?menu_no=443&brd_mgrno=.
  2. den Daas N. Estimating length of survival in end-stage cancer: a review of the literature. J Pain Symptom Manage 1995;10:548-55. https://doi.org/10.1016/0885-3924(95)00103-6
  3. Yoon HS, Kim CM, Lee YJ, Yoon JH, Jung HJ, Sin EK, et al. Clinical prediction of survival in terminal cancer patients: individual assessment vs. interdisciplinary assessment. Korean J Fam Pract 2015;5:89-94.
  4. Morita T, Tsunoda J, Inoue S, Chihara S. The Palliative Prognostic Index: a scoring system for survival prediction of terminally ill cancer patients. Supportive Care Cancer 1999;7:128-33. https://doi.org/10.1007/s005200050242
  5. Anderson F, Downing GM, Hill J, Casorso L, Lerch N. Palliative performance scale (PPS): a new tool. J Palliat Care 1996;12:5-11.
  6. Coussens LM, Werb Z. Inflammation and cancer. Nature 2002;420:860-7. https://doi.org/10.1038/nature01322
  7. Maltoni M, Caraceni A, Brunelli C, Broeckaert B, Christakis N, Eychmueller S, 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. https://doi.org/10.1200/JCO.2005.06.866
  8. Geissbuhler P, Mermillod B, Rapin CH. Elevated serum vitamin B12 levels associated with CRP as a predictive factor of mortality in palliative care cancer patients: a prospective study over five years. J Pain symptom Manage 2000;20:93-103. https://doi.org/10.1016/S0885-3924(00)00169-X
  9. McMillan DC, Canna K, McArdle CS. Systemic inflammatory response predicts survival following curative resection of colorectal cancer. Br J Surg 2003;90:215-9. https://doi.org/10.1002/bjs.4038
  10. Maltoni M, Pirovano M, Nanni O, Marinari M, Indelli M, Gramazio A, et al. Biological indices predictive of survival in 519 Italian terminally ill cancer patients. Italian Multicenter Study Group on Palliative Care. J Pain symptom Manage 1997;13:1-9. https://doi.org/10.1016/S0885-3924(96)00265-5
  11. Zahorec R. Ratio of neutrophil to lymphocyte counts-rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy 2001;102:5-14.
  12. Hawkins WG, DeMatteo RP, Jarnagin WR, Ben-Porat L, Blumgart LH, Fong Y. Jaundice predicts advanced disease and early mortality in patients with gallbladder cancer. Ann Surg Oncol 2004;11:310-5. https://doi.org/10.1245/ASO.2004.03.011
  13. Walenta S, Mueller-Klieser WF. Lactate: mirror and motor of tumor malignancy. Semin Radiat Oncol 2004;14:267-74. https://doi.org/10.1016/j.semradonc.2004.04.004
  14. Lee DH, Kim SH, Choi YS, Chun BC, Hong MH, Cho KH, et al. The effects of performance status, clinical symptoms and laboratoy data on length of survival of advanced cancer patients. Korean J Fam Med 2001;22:1794-805.
  15. Lee JA, Yoon HM, Choi YS, Yeon JE, Lee JY. The effects of plasma endotoxin level on survival time of terminally ill cancer patients. Korean J Hosp Palliat Care 2014;17:57-65. https://doi.org/10.14475/kjhpc.2014.17.2.57
  16. Kim ES, Lee JK, Kim MH, Noh HM, Jin YH. Validation of the prognosis in palliative care study predictor models in terminal cancer patients. Korean J Fam Med 2014;35:283-94. https://doi.org/10.4082/kjfm.2014.35.6.283
  17. Mor V, Laliberte L, Morris JN, Wiemann M. The Karnofsky performance status scale: an examination of its reliability and validity in a research setting. Cancer 1984;53:2002-7. https://doi.org/10.1002/1097-0142(19840501)53:9<2002::AID-CNCR2820530933>3.0.CO;2-W
  18. Repetto L, Fratino L, Audisio RA, Venturino A, Gianni W, Vercelli M, et al. Comprehensive geriatric assessment adds information to Eastern Cooperative Oncology Group performance status in elderly cancer patients: an Italian Group for Geriatric Oncology Study. J Clin Oncol 2002;20:494-502. https://doi.org/10.1200/JCO.2002.20.2.494
  19. Hodkinson HM. Evaluation of a mental test score for assessment of mental impairment in the elderly. Age Ageing 1972;1:233-8. https://doi.org/10.1093/ageing/1.4.233
  20. Seo MS, Lee YJ. Delirium management: diagnosis, assessment, and treatment in palliative care. Korean J Hosp Palliat Care 2016;19:201-10. https://doi.org/10.14475/kjhpc.2016.19.3.201
  21. Pirovano M, Maltoni M, Nanni O, Marinari M, Indelli M, Zaninetta G, 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. https://doi.org/10.1016/S0885-3924(98)00145-6
  22. Halazun KJ, Aldoori A, Malik HZ, Al-Mukhtar A, Prasad KR, Toogood GJ, et al. Elevated preoperative neutrophil to lymphocyte ratio predicts survival following hepatic resection for colorectal liver metastases. Eur J Surg Oncol 2008;34:55-60. https://doi.org/10.1016/j.ejso.2007.02.014
  23. Cho WJ, Hwang HJ, Lee YJ, Son GH, Oh SM, Lee HR, et al. Neutrophil-lymphocyte ratio as a prognostic factor in terminally Ill cancer patients. Korean J Hosp Palliat Care 2008;11:181-7.
  24. Maher EJ. How long have I got doctor? Eur J Cancer 1994;30A:283-4.
  25. Yang SH, Park SJ, Lee JS, Kwon OY, Choi HS, Hong HP, et al. Predictive factors for short-term mortality in terminal cancer patients who visit an emergency department. J Korean Soc Emerg Med 2010;21:465-73.
  26. Kutner JS, Blake M, Meyer SA. Predictors of live hospice discharge: data from the National Home and Hospice Care Survey (NHHCS). Am J Hosp Palliat Care 2002;19:331-7. https://doi.org/10.1177/104990910201900510
  27. Forster LE, Lynn J. Predicting life span for applicants to inpatient hospice. Arch Intern Med 1988;148:2540-3. https://doi.org/10.1001/archinte.1988.00380120010003
  28. Shin HS, Lee HR, Lee DC, Shim JY, Cho KH, Suh SY. Uric acid as a prognostic factor for survival time: a prospective cohort study of terminally ill cancer patients. J Pain Symptom Manage 2006;31:493-501. https://doi.org/10.1016/j.jpainsymman.2005.11.014
  29. Yeom CH, Choi YS, Lee HR, Hong YS, Park YG. Prediction of life expectancy for terminally Ill cancer patients based on clinical parameters. Korean J Hosp Palliat Care 2002;5:111-24.
  30. Caraceni A, Nanni O, Maltoni M, Piva L, Indelli M, Arnoldi E, et al. Impact of delirium on the short term prognosis of advanced cancer patients. Cancer 2000;89:1145-9. https://doi.org/10.1002/1097-0142(20000901)89:5<1145::AID-CNCR24>3.0.CO;2-X
  31. Jang JE, Kim SW, Kim YH, Kim SY, Kim JM, Shin IS, et al. Relationship between severity of delirium and mortality in patients with cancer. J Korean Soc Biol Ther Psychiatry 2011;17:131-9.
  32. Faris M. Clinical estimation of survival and impact of other prognostic factors on terminally ill cancer patients in Oman. Support Care Cancer 2003;11:30-4.
  33. Reuben DB, Mor V, Hiris J. Clinical symptoms and length of survival in patients with terminal cancer. Arch Intern Med 1988;148:1586-91. https://doi.org/10.1001/archinte.1988.00380070082020
  34. Song DS, Yeo CD, Park JM, Sun DS, Hwang HS, Park SA, et al. The prevalence of fatigue in cancer patients at St. Vincent's hospital. Korean J Med 2007;73:512-8.
  35. Kim JH, Choi YS. The last hours of living: practical advice for clinicians. J Korean Med Assoc 2009;52:697-704. https://doi.org/10.5124/jkma.2009.52.7.697
  36. Koh SJ, Lee KS, Hong YS, Yoo YS, Park HJ. Clinical change of terminally ill cancer patients at the end-of-life time. Korean J Hosp Palliat Care 2008;11:99-105.
  37. Byers TE, Wolf HJ, Bauer KR, Bolick-Aldrich S, Chen VW, Finch JL, et al. The impact of socioeconomic status on survival after cancer in the United States: findings from the National Program of Cancer Registries Patterns of Care Study. Cancer 2008;113:582-91. https://doi.org/10.1002/cncr.23567
  38. Albano JD, Ward E, Jemal A, Anderson R, Cokkinides VE, Murray T, et al. Cancer mortality in the United States by education level and race. J Natl Cancer Inst 2007;99:1384-94. https://doi.org/10.1093/jnci/djm127
  39. Lee JY, Jang JS, Park YI, Kim NK, Choe CY, Kim WH, et al. The immunological characteristics of tumor infiltrating lymphocytes and tumor draining lymph node lymphocytes in advanced stomach cancer. J Korean Cancer Assoc 1992;24:656-65.
  40. Walsh SR, Cook EJ, Goulder F, Justin TA, Keeling NJ. Neutrophil-lymphocyte ratio as a prognostic factor in colorectal cancer. J Surg Oncol 2005;91:181-4. https://doi.org/10.1002/jso.20329
  41. Sasaki A, Kai S, Endo Y, Iwaki K, Uchida H, Tominaga M, et al. Prognostic value of preoperative peripheral blood monocyte count in patients with colorectal liver metastasis after liver resection. J Gastrointest Surg 2007;11:596-602. https://doi.org/10.1007/s11605-007-0140-0
  42. Hirashima M, Higuchi S, Sakamoto K, Nishiyama T, Okada H. The ratio of neutrophils to lymphocytes and the phenotypes of neutrophils in patients with early gastric cancer. J Cancer Res Clin Oncol 1998;124:329-34. https://doi.org/10.1007/s004320050178
  43. Nakahara Y, Mochiduki Y, Miyamoto Y, Nakahara Y, Katsura Y. Prognostic significance of the lymphocyte-to-neutrophil ratio in percutaneous fine-needle aspiration biopsy specimens of advanced nonsmall cell lung carcinoma. Cancer 2005;104:1271-80. https://doi.org/10.1002/cncr.21290
  44. Lee GJ, Ahn HS, Go SE, Kim JH, Seo MW, Kang SH, et al. Patient's factors at entering hospice affecting length of survival in a hospice center. Cancer Res Treat 2015;47:1-8.
  45. Son HR, Kim DE, Kang HW, Kim HN, Seo IK, Yoon JY, et al. Survival prediction in terminally ill cancer patients: laboratory variables and prospective validation of the palliative prognostic index. Korean J Med 2011;81:359-65.
  46. Hannan JL, Radwany SM, Albanese T. In-hospital mortality in patients older than 60 years with very low albumin levels. J Pain symptom Manage 2012;43:631-7. https://doi.org/10.1016/j.jpainsymman.2011.04.009
  47. Kao YH, Chen CN, Chiang JK, Chen SS, Huang WW. Predicting factors in the last week of survival in elderly patients with terminal cancer: a prospective study in southern Taiwan. J Formos Med Assoc 2009;108:231-9. https://doi.org/10.1016/S0929-6646(09)60057-7
  48. Shin EK, Kim CM, Lee YJ, Yoon JH, Jung HJ, Yoon HS, et al. Association between blood calcium level and survival time in terminal cancer patients. Korean J Fam Pract 2015;5(Suppl 3):S599-S603.