Correspondence

Palliative care in urban areas of China

To investigate doctors’ feelings when providing medical care to end-stage patients, and their understanding as well as reflection about theoretical concepts of palliative medicine.

Questionnaires were delivered through a social networking platform to 1500 clinicians of different specialties in 10 proviences of China. It covered issues of background information, self-assessment of familiarity to palliative care, prior training history, emotional attitude toward end-stage patients, and the reflections on clinical practice. Logistic regression analysis and chi-square test were used to analyse the categorical variables.

There were 379 clinicians who completed the questionnaires and submitted successfully. Among them, 66.8% (253/379) had attended palliative care training courses more than twice; 66.8% (253/379) clinicians percieved powerless feeling when facing end-stage patients. We found that the education on palliative medicine was significantly associated to doctors’ better comprehension on the concept of palliative care (OR=6.923, P=0.002). Doctors who were more familiar with palliative medicine were less likely to perceive powerless feelings (χ²=13.015, P<0.001), and would be more likely to concern about patients and their family members in their dinical work (χ²=28.754, P<0.001, χ²=24.406, P<0.001).

The powerless feeling is prevalent in Chinese doctors when facing end-stage patients. Palliative care help them overcome the negative feelings and act more caring in clinic. More careful designed educational strategies that adapt to Chinese actual situation are needed to improve doctors’ cognition on palliative care.

This study was designed to assess the disease-related symptom burden and quality of life (QOL) in Chinese chemo-naïve advanced lung cancer patients.

Chemo-naïve patients with stage III/IV lung cancer were enrolled. 43 centers from 16 provinces of China participated in the study. Functional Assessment of Cancer Therapy-Lung (FACT-L) scale and Cloud QOL System were applied in the study.

376 eligible patients were analyzed. The three most common and severe symptoms were appetite loss (84.3%, scored 2.46), breathing difficulty (79.0%, scored 2.56), and cough (75.5%, scored 2.81). Significant correlation was found between QOL and symptoms. Regression analysis of QOL indicated that almost every symptom item (except shortness of breath) was the negative indicator of QOL. Moreover, pulmonary diseases, pleural metastases and brain metastases had significant negative impact on both symptoms and QOL. Relatively poor performance status affected the QOL only, while cardiovascular diseases merely affected the symptoms. And patients with EGFR mutations had less symptom burden than those with wild-type EGFR.

QOL evaluation by using the Cloud QOL System was feasible. Appetite loss, breathing difficulty and cough were the three most common and severe symptoms seen in Chinese chemo-naïve advanced lung cancer patients. Almost all symptoms had negative impact on QOL. And some clinical characteristics could predict the symptoms and QOL.