Charakteristika von Palliativpatienten mit Atemnot

 

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Zusammenfassung

Hintergrund | Atemnot ist ein häufiges und belastendes Symptom bei Patienten mit fortgeschrittener lebenslimitierender Erkrankung. Das Ziel dieser Untersuchung war die Beschreibung demografischer und klinischer Charakteristika von Patienten mit Atemnot in Deutschland.

Methoden | Wir führten eine Sekundäranalyse von Patientendaten der nationalen Erhebung aus spezialisierten stationären Hospiz- und Palliativeinrichtungen von 2006 bis 2008 durch. Die Hospiz- und Palliativ-Erfassung (HOPE) erhebt jährlich prospektiv deutschlandweit u.a. anhand einer validierten Checkliste standardisiert 16 Symptome und Probleme (Schweregrad 0–3).

Die Charakteristika von Patienten mit Atemnot (PmA) und ohne (PoA) wurden rein deskriptiv verglichen. Bei der Interpretation der angegebenen p-Werte wurde die Fehlerinflation aufgrund multipler Tests berücksichtigt.

Ergebnisse | Bei 2860/5320 (53,8 %) Patienten wurde Atemnot dokumentiert (Durchschnittsalter 67,2 ± 12,4 Jahre, 51,4 % der Patienten waren weiblich. 2676 Patienten mit Atemnot (93,6 %) hatten eine maligne Grunderkrankung (weiblich / männlich:

• Lungenkrebs: 15,7 %/29,5 %

• Brustkrebs: 20,3 %/0,3 %

• Dickdarmkrebs: 10,3 %/8,7 %

PmA hatten einen signifikant schlechteren Funktionsstatus als PoA (ECOG 3/4: 78,4 % vs. 70,8 %, p < 0,001) und eine höhere Symptomanzahl und -Intensitätslast (außer Verwirrtheit). PmA hatten ein höheres assoziiertes Risiko, während des stationären Aufenthalts zu sterben (43,5 % vs. 32,4 %, p < 0,001).

Folgerung | In dieser umfassenden Studienpopulation aus spezialisierten stationären Hospiz- und Palliativeinrichtungen war Atemnot mit einer höheren Symptomanzahl und einer geringeren Überlebenszeit assoziiert. PmA benötigen eine besondere Aufmerksamkeit in der Versorgung.

Abstract

Background: Breathlessness is a common and distressing symptom in patients with advanced life-limiting disease. The aim of this study was to describe demographical and clinical characteristics of patients with breathlessness in Germany.

Methods: We conducted a secondary analysis of hospice and palliative care inpatient data from 2006 to 2008. The Hospice and Palliative Care Evaluation (HOPE) is an annual prospective German survey, that includes a validated 16-item symptom-and-problem checklist (severity score 0–3). Characteristics of patients with or without breathlessness were compared in a pure descriptive manner. Interpretation of given p-values takes the error inflation due to multiple testing into account.

Results: Breathlessness was recorded in 2860/5320 (53.8 %) patients (mean age 67.2 years (SD 12.4), 51.4 % female, 93.6 % malignant disease (female / male lung cancer 15.7/29.5 %, breast cancer 20.3/0.3 %, colon 10.3/8.7 %)). Breathless patients compared with those without breathless ness had a significantly worse functional status (ECOG 3–4: 78.4 % vs. 70.8 %, p < 0.001), suffered from a larger number (11.1 vs. 9.5, p < 0.001) of symptoms and the symptoms were of higher intensity (except confusion). Breathless patients had a higher risk to die during inpatient stay (43.5 % vs. 32.4 %, p < 0.001).

Conclusion: Based on this large sample of hospice and palliative care inpatients, breathlessness is associated with a high symptom burden and shortened survival. Breathless patients need more attention in health care.

^* geteilte Erstautorenschaft

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