Survival of cancer patients under treatment with the palliative care team in a Brazilian hospital in São Paulo
Abstract
Introduction: The Karnofsky Performance Status Scale is a relevant functional evaluation instrument that can be used to determine which patients should be followed by multidisciplinary palliative care teams.
Objective: To analyze the clinical outcomes of patients with performance status lower than 70%, according to the Karnofsky Scale, who received care from a palliative care team compared to those who did not receive care from a palliative care team.
Methods: In this retrospective cohort, follow-up of cancer patients by the palliative care team for 10 days was considered the exposure factor, while the dependent variable was patient survival. Data were extracted from medical records and descriptive and survival curve analyses were conducted.Â
Results: Among 581 participants in the sample, 42.5% had metastasis, and the most prevalent medical diagnosis was gastrointestinal cancer (29.1%). Fifty-one (8.7%) were followed by the palliative care team. The mortality rate during the 10 days in the sample was 10.8%, and the rate was higher (15.7%) among patients followed by the palliative care team.
Conclusion: Patients with a performance status below 70% who were followed by the palliative care team had poorer clinical conditions and a shorter survival than those who were not followed up by the team.
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Academia Nacional de Cuidados Paliativos (ANCP). (2012). Manual de cuidados paliativos [Paliative care manual] (2a ed.). Diagraphic. Recovered from http://biblioteca.cofen.gov.br/wp-content/uploads/2017/05/Manual-de-cuidados-paliativos-ANCP.pdf
Bekelman, J. E., Halpern, S. D., Blankart, C. R., Bynum, J. P., Cohen, J., Fowler, R., Kaasa, S, Kwietniewski L., ... International Consortium for End-of-Life Research. (2016). Comparison of site of death, health care utilization, and hospital expenditures for patients dying with cancer in 7 developed countries. JAMA, 315(3), 272–283. https://doi.org/10.1001/jama.2015.18603. https://jamanetwork.com/journals/jama/fullarticle/2482325
Cabianca, C. A. M., Menegheti, G. G., Bernardi, I. C. P., & Gurgel, S. J. T. (2017). Comparação entre Escala de Performance de Karnofsky e Escala de Avaliação de Sintomas de Edmonton como determinantes da assistência paliativa. [Comparison of Karnofsky Performance Status Scale and Edmonton Symptom Assessment Scale as determinants in palliative assistance]. Rev Soc Bras Clin Med., 15(1), 2–5. http://www.sbcm.org.br/ojs3/index.php/rsbcm/article/view/239/227
Chow, K., & Dahlin, C. (2018). Integration of palliative care and oncology nursing. Semin Oncol Nurs., 34(3), 192–201. https://doi.org/10.1016/j.soncn.2018.06.001. Recovered from: https://pubmed.ncbi.nlm.nih.gov/30119999/
Colombet, I., Bouleuc, C., Piolot, A., Vilfaillot, A., Voisin-Satiel, S., Goldwasser, F., Vinant, P., & EFIQUAVIE Study Group. (2019). Multicentre analysis of intensity of care at the end-of-life in patients with advanced cancer, combining health administrative data with hospital records: Variations in practice call for routine quality evaluation. BMC Palliat Care, 18(1), 35. https://doi.org/10.1186/s12904-019-0419-4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6451228/pdf/12904_2019_Article_419.pdf.
Ferrell, B. R., Temel, J. S., Temin, S., Alesi, E. R., Balboni, T. A., Basch, E. M., ... Smith, T. J. (2017). Integration of palliative care into standard oncology care: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol., 35(1), 96–112. https://doi.org/10.1200/JCO.2016.70.1474. https://ascopubs.org/doi/pdf/10.1200/JCO.2016.70.1474
Hui, D., Kim, S. H., Roquemore, J., Dev, R., Chisholm, G., & Bruera, E. (2014). Impact of timing and setting of palliative care referral on quality of end-of-life care in cancer patients. Cancer, 120(11), 1743–1749. https://doi.org/10.1002/cncr.28628. https://acsjournals.onlinelibrary.wiley.com/doi/epdf/10.1002/cncr.28628.
Hui, D. (2015). Prognostication of survival in patients with advanced cancer: predicting the unpredictable? Cancer Control., 22(4), 489–497. https://doi.org/10.1177/107327481502200415. https://journals.sagepub.com/doi/pdf/10.1177/107327481502200415
Hui, D., Mori, M., Meng, Y. C., Watanabe, S. M., Caraceni, A., Strasser, F. ... Bruera, E. (2018). Automatic referral to standardize palliative care access: An international Delphi survey. Support Care Cancer, 26(1), 175–180. https://doi.org/10.1007/s00520-017-3830-5. https://link.springer.com/content/pdf/10.1007/s00520-017-3830-5.pdf
Hui, D., Hannon, B., Zimmermann, C., & Bruera, E. (2018). Improving patient and caregiver outcomes in oncology: Team-based, timely, and targeted palliative care. CA Cancer J Clin, 68, 356–376. https://doi.org/https://doi.org/10.3322/caac.21490. https://acsjournals.onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21490
Instituto Nacional de Câncer. (2018). Cuidados paliativos: tratamento [Paliative care: treatment]. BrasÃlia, DF: Ministério da Saúde. http://www2.inca.gov.br/wps/wcm/connect/cancer/site/tratamento/cuidados_paliativos.
Jang, R. W, Caraiscos, V. B., Swami, N., Banerjee, S., Mak, E., Kaya, E., ... Zimmermann, C. (2014). Simple prognostic model for patients with advanced cancer based on performance status. J Oncol Pract., 10(5), e335–341. https://doi.org/10.1200/JOP.2014.001457. https://ascopubs.org/doi/pdf/10.1200/JOP.2014.001457
Jensen, H. I., Halvorsen, K., Jerpseth, H., Fridh, I., & Lind, R. (2020). Practice recommendations for end-of-life care in the intensive care unit. Critical Care Nurse, 40(3), 14–22. https://doi.org/10.4037/ccn2020834. https://doi-org.ez334.periodicos.capes.gov.br/10.4037/ccn2020834.
Kelley, A. S., & Morrison, R. S. (2015). Palliative care for the seriously III. N Engl J Med., 373(8), 747–755. https://doi.org/10.1056/NEJMra1404684. https://www.nejm.org/doi/pdf/10.1056/NEJMra1404684?articleTools=true
Lima, G. S., & Nascimento, N. M. (2017). Oncologia: cuidados paliativos aos pacientes oncológicos. [Oncology: palliative care for oncology patiets]. Temas em Saude, 17(1), 281–331. https://temasemsaude.com/wp-content/uploads/2017/05/17116.pdf
Mendes, J. A., Lustosa, M. A., & Andrade, M. C. M. (2009). Paciente terminal, famÃlia e equipe de saúde. [Terminally ill patient, family and health staff]. Rev. SBPH, 12(1), 151–173. http://pepsic.bvsalud.org/pdf/rsbph/v12n1/v12n1a11.pdf.
Quintana, A. M., Kegler, P., Santos, M. S., & Lima, L. D. (2006). Sentimentos e percepções da equipe de saúde frente ao paciente terminal. [Feelings and perceptions of the health staff in front of the terminally ill patient]. Paidéia, 16(35), 415–425. https://doi.org/10.1590/S0103-863X2006000300012. https://www.scielo.br/j/paideia/a/BDw4yJP4N3Vt6c3ctgxk7qG/?lang=pt
Rogers, J. L., Perry, L. M., & Hoerger, M. (2020). Summarizing the evidence base for palliative oncology care: A critical evaluation of the meta-analyses. Clin Med Insights Oncol., https://doi.org/10.1177/1179554920915722. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7171985/pdf/10.1177_1179554920915722.pdf
Soares, L. G. L., Gomes, R. V., Palma, A., & Japiassu, A. M. (2020). Quality indicators of end-of-life care among privately insured people with cancer in Brazil. Am J Hosp Palliat Care. 37(8), 594–599. https://doi.org/10.1177/1049909119888180. https://pubmed.ncbi.nlm.nih.gov/31726853
Soares, L. G. L., Gomes, R. V., & Japiassu, A. M. (2019). Trends in health-care utilization at the end of life among patients with hematologic malignancies in a middle-income country: Challenges and opportunities in Brazil. Am. J. Hosp Palliat Care, 36(9) 775–779. https://doi.org/10.1177/1049909119828086. https://pubmed.ncbi.nlm.nih.gov/30744400
Temel, J. S., Greer, J. A., Muzikansky, A., Gallagher, E. R., Admane, S., Jackson, V.A., ... Lynch, T. J. (2010). Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med., 363(8), 733–742. https://doi.org/10.1056/NEJMoa1000678. https://www.nejm.org/doi/pdf/10.1056/NEJMoa1000678?articleTools=true
World Health Organization & World Palliative Care Alliance. (2020). Global atlas of palliative care at the end of life. Geneva: World Health Organization. http://www.who. int/nmh/Global_Atlas_of_Palliative_Care.pdf
Yates, P., Miaskowski, C., Cataldo, J. K., Paul, S. M., Cooper, B. A., Alexander, K., ... Skerman, H. (2015). Differences in composition of symptom clusters between older and younger oncology patients. J Pain Symptom Manage., 49(6), 1025–1034. https://doi.org/10.1016/j.jpainsymman.2014.11.296. https://www.jpsmjournal.com/action/showPdf?pii=S0885-3924%2815%2900002-0.
Yates, P. (2017) Symptom management and palliative care for patients with cancer. Nurs Clin North Am., 52(1), 179–191. https://doi.org/10.1016/j.cnur.2016.10.006. https://www.sciencedirect.com/sdfe/pdf/download/eid/1-s2.0-S0029646516300718/first-page-pdf
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