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Cancer care for people with dementia: Literature overview and recommendations for practice and research.
文献信息
| DOI | 10.3322/caac.21767 |
|---|---|
| PMID | 36512303 |
| 期刊 | CA: a cancer journal for clinicians |
| 影响因子 | 232.4 |
| JCR 分区 | Q1 |
| 发表年份 | 2023 |
| 被引次数 | 8 |
| 关键词 | 癌症、共病、痴呆、老年肿瘤学、健康差异 |
| 文献类型 | Journal Article, Review |
| ISSN | 0007-9235 |
| 页码 | 320-338 |
| 期号 | 73(3) |
| 作者 | Laura Ashley, Claire Surr, Rachael Kelley, Mollie Price, Alys Wyn Griffiths, Nicole R Fowler, Dana E Giza, Richard D Neal, Charlene Martin, Jane B Hopkinson, Anita O'Donovan, William Dale, Bogda Koczwara, Katie Spencer, Lynda Wyld |
一句话小结
随着人口老龄化，痴呆症患者在癌症诊断和治疗中面临健康差异，研究发现他们更可能在晚期被诊断，接受的治疗较少且生存率低。本文强调了为痴呆症患者提供个性化、以人为本的癌症护理的重要性，并呼吁优化临床实践以减少相关风险和支持家庭照顾者。
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摘要
随着许多国家经历人口老龄化，癌症患者的年龄逐渐增大，且往往伴有更多的既往合并症，其中包括普遍存在的与年龄相关的慢性病，如痴呆。生活在痴呆状态中的人（PLWD）面临健康差异的脆弱性，痴呆症有很大的潜力 complicate 并对癌症治疗及结果产生不利影响。该报告概述了痴呆症及其在癌症患者中的流行情况，并总结了研究文献中关于为PLWD提供癌症护理的相关研究。所评审的研究表明，PLWD 更可能在晚期被诊断为癌症，接受的癌症治疗较少或治疗范围较小，并且在癌症诊断后的生存率较低。这些癌症差异并不一定意味着对痴呆患者的诊断不当或治疗不足，且从某种意义上说，它们作为护理优化的目标并不那么可行或合适。所评审的研究还表明，PLWD 在癌症相关紧急情况的发生风险增加，癌症相关决策过程中质量较低，癌症检查和治疗的可及性障碍，经历更高的治疗负担以及家庭照顾者面临更大的负担，同时癌症相关疼痛常常得不到充分治疗。作者建议，为PLWD提供最佳癌症护理应重点主动减少这些风险领域，因此必须高度以人为本，进行全面的决策，个性化合理的实践调整，并强有力地支持和包容家庭照顾者。为临床实践和未来研究提供了全面的建议，以帮助临床医生和提供者为PLWD及其家庭提供最佳和公平的癌症护理。
英文摘要
As many countries experience population aging, patients with cancer are becoming older and have more preexisting comorbidities, which include prevalent, age-related, chronic conditions such as dementia. People living with dementia (PLWD) are vulnerable to health disparities, and dementia has high potential to complicate and adversely affect care and outcomes across the cancer trajectory. This report offers an overview of dementia and its prevalence among patients with cancer and a summary of the research literature examining cancer care for PLWD. The reviewed research indicates that PLWD are more likely to have cancer diagnosed at an advanced stage, receive no or less extensive cancer treatment, and have poorer survival after a cancer diagnosis. These cancer disparities do not necessarily signify inappropriately later diagnosis or lower treatment of people with dementia as a group, and they are arguably less feasible and appropriate targets for care optimization. The reviewed research indicates that PLWD also have an increased risk of cancer-related emergency presentations, lower quality processes of cancer-related decision making, accessibility-related barriers to cancer investigations and treatment, higher experienced treatment burden and higher caregiver burden for families, and undertreated cancer-related pain. The authors propose that optimal cancer care for PLWD should focus on proactively minimizing these risk areas and thus must be highly person-centered, with holistic decision making, individualized reasonable adjustments to practice, and strong inclusion and support of family carers. Comprehensive recommendations are made for clinical practice and future research to help clinicians and providers deliver best and equitable cancer care for PLWD and their families.
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主要研究问题
- 在为患有痴呆症的癌症患者提供护理时，如何有效地评估和管理他们的治疗负担？
- 有哪些针对痴呆症患者的癌症治疗方法可以减少他们在治疗过程中的痛苦和不适？
- 在癌症治疗过程中，家属的角色和支持如何影响痴呆症患者的治疗效果？
- 针对痴呆症患者的癌症护理，当前有哪些最佳实践和成功案例可以借鉴？
- 如何在癌症护理中实施以患者为中心的决策过程，以满足痴呆症患者的独特需求？
核心洞察
1. 研究背景和目的
随着全球人口老龄化的加剧，癌症患者的年龄逐渐增大，且伴有更多的合并症，其中老年性慢性疾病如痴呆症的发病率显著增加。痴呆患者在癌症治疗中面临健康差异，痴呆症可能会使癌症的治疗和结果复杂化并产生负面影响。此研究旨在回顾痴呆症与癌症患者之间的关系，探讨现有文献中关于痴呆患者癌症护理的研究，并提出针对临床实践和未来研究的建议。
2. 主要方法和发现
该文献综述整理了痴呆症在癌症患者中的流行病学情况，以及相关的研究文献。研究表明，痴呆患者更可能在癌症晚期被诊断，接受的癌症治疗较少或不够充分，且在癌症诊断后的生存率较低。此外，痴呆患者在癌症相关急诊就诊的风险更高，决策过程质量较低，面临癌症检查和治疗的可及性障碍，体验到更大的治疗负担和家庭照护者的负担，以及癌症相关疼痛未被充分治疗。
3. 核心结论
为了优化痴呆患者的癌症护理，必须关注减少上述风险领域，采取以患者为中心的护理方法。这种方法应包括全面的决策制定、个性化的实践调整，以及对家庭照护者的强有力支持和参与。研究强调，痴呆患者的癌症护理不应简单依赖于诊断和治疗的时机，而应更关注患者的整体护理体验和生活质量。
4. 研究意义和影响
本研究对临床实践具有重要的指导意义，提出了全面的建议，旨在帮助临床医师和服务提供者为痴呆患者及其家庭提供最佳和公平的癌症护理。通过强调个性化和以患者为中心的护理方法，可以有效改善痴呆患者在癌症治疗中的体验和结果。此外，该研究为未来的研究提供了方向，鼓励进一步探索如何在癌症护理中更好地整合痴呆症患者的需求，从而推动相关领域的发展和优化。
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- Exploring the perceptions of New Zealand Chinese dementia carers on the adapted world health organization iSupport manual: A qualitative study. - Fei Li;John Parsons;Lily Dongxia Xiao;Gary Cheung - Dementia (London, England) (2025)
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- Emergency colon cancer diagnosis in people with mental health conditions: a population-based cohort study in northern Italy. - Flavia Pennisi;Carlotta Buzzoni;Federico Gervasi;Antonio Giampiero Russo;Cristina Renzi - BMJ mental health (2025)
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