緩和ケアと医学

抽象的な

Prognostic Factors and Clinical Characteristics in Elderly Patients with Advanced Cancer at the End-of-Life

Shuji Hiramoto, Tetsuo Hori, Ayako Kikuchi, Akira Yoshioka, Tomoko Tamaki

Purpose: End-of-life characteristics, indicators of palliative care, and their prognosis in especially elderly cancer patients remain unclear.

Methods: We retrospectively analysed 510 patients who died of advanced cancer at our hospital from August 2011 to August 2016. We divide into categories elderly patients (80 years and older) (N=140) and non-elderly patients (under 80 years old) (N=370). The primary endpoint was to identify prognostic factors in elderly patients with advanced cancer at the end of life. The secondary endpoint was to analyse the relationship between details of end-of-life symptom, treatment, and their age.

Results: Background as follows: Male and female were 306 and 204. Patients with gastro-oesophageal, biliarypancreatic, colorectal, lung, breast, urological and gynaecological, hepatocellular, and others were 114, 98, 82, 84, 25, 36, 20, and 51 by primary cancer site. ECOG-Performance Status was 12 in 0.1, and 498 in 2-4. In multivariate analysis of prognosis in elderly patients at the end-of-life, sex (HR1.252, p=0.041) and consciousness level (HR 1.714, p=0.048) were significant prognostic factors. The prevalence rate of cancer pain in elderly patients was 19.3%, which was significantly lower than in non-elderly (31.4%). Fatigue in elderly patients was 27.9%, which was significantly lower than in non-elderly (37.6%). Continuous deep sedation usage in elderly patients was 12.9%, which was significantly lower than in non-elderly (28.9%). The mean opioid dose in elderly patients was 23.3mg/day, which was significantly lower than that in non-elderly patients (43.8mg/day).

Conclusions: Consciousness level and sex were significant prognostic factors in elderly patients at the end of life. The prevalence rate of end-of-life symptoms was lower, the end-of-life intervention includes anti-cancer treatment in elderly patients was more reluctant than non-elderly.