患有癌症的青少年和年轻人 (AYAs) 会经历严重的症状负担。建议进行专业姑息治疗 (SPC)，但通常不参与或参与较晚。为了确定患者报告的症状严重程度是否与随后的 SPC 参与相关，以及 SPC 是否与患有癌症的 AYAs 的症状改善相关。这项队列研究包括 AYAs（老年） 2010年1月1日至2018年6月30日期间在加拿大安大略省诊断出的原发性癌症（15-29岁）。包括自我报告的埃德蒙顿症状评估系统（ESAS）评分在内的数据来自医疗保健数据库。通过计费代码和经过验证的算法来识别专业姑息治疗。最终数据分析于 2023 年 4 月 4 日进行。确定了 ESAS 评分与随后 SPC 参与的关联。对于癌症诊断后 5 年内死亡的患者采用双重差分法。病例患者（SPC 死亡前，索引日期等于第一次 SPC 服务）与对照患者（死亡前同等时间没有 SPC）以 1:1 进行匹配。该研究检查了病例和对照患者之间 90 天的指数后和指数前平均 ESAS 评分之间的差异本身是否不同。这项研究包括 5435 名患有癌症的 AYA，中位随访时间为 5.1（IQR，2.5-7.9）年。一般姑息治疗的分析。他们诊断癌症时的中位年龄为 25 岁（IQR，22-27）岁，其中一半以上为男性（2809 [51.7%]）。对于所有症状，与轻度评分相比，中度和重度 ESAS 评分与 SPC 受累的可能性增加相关。疼痛评分的相关性最大（严重与轻度的风险比，7.7 [95% CI，5.8-10.2]；P < .001）。共有 721 名 AYA（13.3%）在诊断后 5 年内死亡，其中 612 名患者（84.9%）在死亡前接受过 SPC。在 202 对病例对照中，SPC 的参与与疼痛轨迹的改善相关（病例患者的平均评分从 3.41 改善至 3.07，对照患者的平均评分从 1.86 恶化至 2.16；P = .003）。其他症状轨迹不受影响。 在这项癌症 AYA 队列研究中，那些通过筛查计划报告中度或重度症状的人更有可能随后接受 SPC。这些发现表明，SPC 与随后疼痛严重程度的减轻有关，但不影响其他症状。需要针对治疗期间，特别是临终时的其他症状采取新的干预措施。

Adolescents and young adults (AYAs) with cancer experience substantial symptom burden. Specialty palliative care (SPC) is recommended but often not involved or involved late.To determine whether patient-reported symptom severity was associated with subsequent SPC involvement and whether SPC was associated with symptom improvement in AYAs with cancer.This cohort study comprised AYAs (aged 15-29 years) with primary cancer diagnosed between January 1, 2010, and June 30, 2018, in Ontario, Canada. Data, including self-reported Edmonton Symptom Assessment System (ESAS) scores, were obtained from health care databases. Specialty palliative care was identified through billing codes and validated algorithms. Final data analysis was performed on April 4, 2023.Associations of ESAS scores with subsequent SPC involvement were determined. A difference-in-differences approach was used for patients who died within 5 years of their cancer diagnosis. Case patients (SPC predeath, index date equals first SPC service) were matched 1:1 to control patients (no SPC at equivalent time before death). The study examined whether the difference between 90-day postindex and preindex mean ESAS scores was itself different between case and control patients.This study included 5435 AYAs with cancer, with a median follow-up of 5.1 (IQR, 2.5-7.9) years for analyses of general palliative care. Their median age at cancer diagnosis was 25 (IQR, 22-27) years, and more than half were male (2809 [51.7%]). For all symptoms, moderate and severe ESAS scores were associated with an increased likelihood of SPC involvement compared with mild scores. The greatest magnitude of association was seen for pain scores (hazard ratio for severe vs mild, 7.7 [95% CI, 5.8-10.2]; P < .001). A total of 721 AYAs (13.3%) died within 5 years of diagnosis, and 612 of these patients (84.9%) had received SPC before death. Among 202 case-control pairs, SPC involvement was associated with improved pain trajectories (mean scores improved from 3.41 to 3.07 in case patients and worsened from 1.86 to 2.16 in control patients; P = .003). Other symptom trajectories were not affected.In this cohort study of AYAs with cancer, those reporting moderate or severe symptoms through a screening program were more likely to subsequently receive SPC. These findings suggest that SPC was associated with a subsequent decrease in pain severity but did not affect other symptoms. New interventions targeting other symptoms during treatment and particularly at the end of life are needed.