Patterns of palliative care utilization across health sectors in patients with aggressive non-Hodgkin lymphoma.
Notice bibliographique
Résumé
Abstract Introduction: Patients with aggressive non-Hodgkin lymphoma (NHL) experience high physical and psychological burden related to their disease and intensive treatment regimens especially with advances in treatment options for relapsed/refractory disease. Palliative care focuses on improving quality of life and controlling symptoms for patients with serious illness at any point during their disease trajectory. Data regarding the patterns of palliative care provision and utilization among patients with aggressive NHL is lacking. Methods: A retrospective cohort study was conducted using population-based health care data in Ontario, Canada. Patients aged 18 years or over who were diagnosed with diffuse large B-cell lymphoma (DLBCL) or transformed follicular lymphoma (tFL) and died between January 2007 and December 2023 were included. We abstracted patient and clinical characteristics and information on the patterns of palliative care services including the timing and setting of palliative encounters and types of services delivered. Results: The cohort included 7270 decedents; 6998 (96.2%) had DLBCL and 272 (3.74%) had tFL. The median age at death was 76 years (IQR 67-83). The mean survival from time of diagnosis to death was 3.38 years. Among 3660 patients with known cancer stage, 2443 (66.7%) presented with stage III or IV disease. 4553 patients (62.2%) had lived for 12 months or longer after their lymphoma diagnosis. Of the 7270 patients who died, 2301 (32%) received palliative care within the last 3 months of life. Over half of these patients (1208/2301; 52.5%) received palliative care within the last month of life. 27% of the entire cohort did not receive any palliative care service prior to death. Of the patients who received palliative care late (within 3 months of death), their first palliative care encounter occurred a median of 55 days before death (IQR 41-72) and largely through community-based palliative services (777/1093; 71%) either via outpatient physician visit or palliative home care services. The remainder 29% of patients received their first palliative care encounter in an institutional setting, most commonly an inpatient hospital admission. Of those who received palliative care early (> 3 months before death), their first palliative care encounter occurred a median of 268 days before death (IQR 159-510) and largely in a community setting (2531/2997; 84.5%). Conclusions: Our study demonstrates that palliative care is initiated very late in the disease trajectory for the majority of patients diagnosed with aggressive NHL, and a significant proportion of patients do not receive any specialty palliative care prior to death. The majority of patients receive their first palliative care encounter in the community as opposed to institutional settings. This suggests an opportunity for close collaboration between hematologists and primary palliative care teams to ensure timely and integrative palliative care for patients with aggressive lymphoma.
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Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».