癌患者さんは自宅の方が長生きできる?

かつて手稲渓仁会病院の緩和ケアチームで勤務されていた山口先生(札幌にいたときは色々こちらがお世話になりました)も参加されていた臨床試験の結果がcancerで発表されていますね。一応下記にabstractのみ引用してみます。

http://onlinelibrary.wiley.com/doi/10.1002/cncr.29844/abstract より

Multicenter cohort study on the survival time of cancer patients dying at home or in a hospital: Does place matter?

BACKGROUND

Although the place of death has a great influence on the quality of death and dying for cancer patients, whether the survival time differs according to the place of death is unclear. The primary aim of this study was to explore potential differences in the survival time of cancer patients dying at home or in a hospital.

METHODS

This multicenter, prospective cohort study was conducted in Japan from September 2012 through April 2014 and involved 58 specialist palliative care services.

RESULTS

Among the 2426 patients recruited, 2069 patients were analyzed for this study: 1582 receiving hospital-based palliative care and 487 receiving home-based palliative care. A total of 1607 patients actually died in a hospital, and 462 patients died at home. The survival of patients who died at home was significantly longer than the survival of patients who died in a hospital in the days’ prognosis group (estimated median survival time, 13 days [95% confidence interval (CI), 10.3-15.7 days] vs 9 days [95% CI, 8.0-10.0 days]; P = .006) and in the weeks’ prognosis group (36 days [95% CI, 29.9-42.1 days] vs 29 days [95% CI, 26.5-31.5 days]; P = .007) as defined by Prognosis in Palliative Care Study predictor model A. No significant difference was identified in the months’ prognosis group. Cox proportional hazards analysis revealed that the place of death had a significant influence on the survival time in both unadjusted (hazard ratio [HR], 0.86; 95% CI, 0.78-0.96; P < .01) and adjusted models (HR, 0.87; 95% CI, 0.77-0.97; P = .01).

CONCLUSIONS

In comparison with cancer patients who died in a hospital, cancer patients who died at home had similar or longer survival. Cancer 2015. © 2015 American Cancer Society.

結論のみ要約すると病院に入院した癌患者さんと自宅で過ごした癌患者さんとでは余命に差がなくむしろ自宅で過ごした方が長かったかも?とのことでした。さらに詳しく中身を述べると日単位、週単位の予後の患者さんは自宅で過ごした方が有意に長くいきることができ、月単位の予後の場合は差がなかったとのことでした。自分の印象としては病院で余命1~2カ月と言われた患者さんでも半年以上自宅で頑張っている患者さんも現にみていますし、これまでも同じように自宅で長く過ごしていた患者さん結構いらっしゃいましたので、自宅で過ごした方が余命が長いと言われたらそうかなぁと感覚的には腑に落ちる感じがします。

まあ正直どちらの方が長く過ごせるのかは個々の患者さんケースバイケースかと思いますが、でも間違いなく自宅の方が生活に自由度があるとは思います。自宅なら喫煙してもお酒を飲んでも構いませんし家族の手料理も少量ですがとれますしいいことが多いなぁと。

この論文が少しでも患者さんが自宅に帰る時に安心させるようなエビデンスとして、自宅復帰の後押しになるように使われればいいですね。山口先生そうですよね?