371例肿瘤姑息治疗多学科会诊临床分析

Clinical analysis of 371 cancer patients on multidisciplinary consultation for palliative treatment

目的:分析天津医科大学肿瘤医院肿瘤姑息治疗多学科专家协作组(Multidisciplinary team,MDT)的工作概况,评价MDT模式在肿瘤姑息治疗领域的作用。方法:回顾性分析2014年1月1日至2015年3月31日参加本院肿瘤姑息治疗MDT会诊的371例患者的临床资料,总结其基本特征、MDT决策执行情况,并对部分姑息治疗方案进行疗效评价。结果:全组患者401例次共获得318(79%)项治疗建议,其中293项为姑息治疗建议。MDT为119例疼痛患者提供了合理化镇痛方案,对95例患者提出营养治疗意见,对36例患者采取了抗焦虑抑郁药物治疗。有效随访到的374项MDT决策,全部执行者273项(73%),部分执行者49项(13%),总体执行率86%。执行MDT决策的患者,在疼痛控制、营养状况改善及与抑郁相关的躯体症状缓解方面均优于未执行者(P<0.001,P<0.001及P<0.01)。结论:肿瘤姑息治疗多学科会诊能为患者提供规范的个体化综合治疗建议,执行MDT决策有助于改善癌症患者疼痛、营养障碍及焦虑抑郁等症状,值得进一步完善和推广。

Objective： The effect of multidisciplinary team （MDT） of palliative treatment on cancer patients was evaluated through analyzing the implementation of this model in Tianjin Medical University Cancer Institute and Hospital. Methods：Clinical da-ta of 371 cancer patients, who attended the consultation by MDT in our hospital from January 1, 2014 to March 31, 2015, were retro-spectively reviewed. The essential characteristics and results of MDT treatment decisions were summarized, and the efficacy of pallia-tive treatment regimens on several patients was evaluated. Results：A total of 401 cases were included in MDT assessment; 318 （79%） treatment recommendations were obtained, 293 of which were palliative. MDT provided reasonable analgesia schedules for 119 pa-tients with pain, nutritional care advices for 95 patients, and anti-anxiety and anti-depressant drugs for 36 patients. A total of 374 MDT decisions were followed up successfully. Among these MDT decisions, 273 （73%） were fully implemented, and 49 （13%） were partially implemented;the rate of executions was 86%. The patients who underwent MDT discussions showed that the improvement of pain con-trol, nutritional status, and physical symptoms associated with anxiety and depression were superior to those patients not discussed （P〈0.001, P〈0.001, and P〈0.01）. Conclusion：The MDT of palliative treatment can provide recommendations of standardized individual-ized comprehensive treatment for cancer patients. Implementation of MDT decision is helpful for relieving pain, nutritional disorders, anxiety and depression, and other clinical symptoms. Therefore, MDT should be further improved and widely used.