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Timing of palliative care access and outcomes of advanced cancer patients referred to an inpatient palliative care consultation team in Brazil

Published online by Cambridge University Press:  10 September 2018

Letícia Taniwaki ,
Pedro Luiz Serrano Usón Junior ,
Polianna Mara Rodrigues de Souza  and
Bernard Lobato Prado
Letícia Taniwaki*
Affiliation:
Oncology and Hematology Department, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
Pedro Luiz Serrano Usón Junior
Affiliation:
Oncology and Hematology Department, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
Polianna Mara Rodrigues de Souza
Affiliation:
Oncology and Hematology Department, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
Bernard Lobato Prado
Affiliation:
Oncology and Hematology Department, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
*
Author for Correspondence: Letícia Taniwaki, M.D., Hospital Israelita Albert Einstein, Centro de Oncologia e Hematologia, Av Albert Einstein 627, São Paulo, Brasil05652-900. E-mail: [email protected]
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Abstract

Objective

Little is known about the outcomes of cancer patients referred to palliative care (PC) teams in developing countries. Our aim was to examine the timing of PC access and outcomes of patients with advanced cancer referred to an inpatient PC consultation team in Brazil.

Method

Retrospective study of consecutive patients with advanced cancer admitted to a tertiary care general hospital (April 2015–December 2016) and referred for the first time to an inpatient PC consultation team. Patients’ demographics, clinical features, time from first consult to death or discharge, and outcomes on medication use, clinical interventions, and end-of-life preferences were retrieved. An analysis was performed before and after PC.

Result

One hundred eleven patients were included. Median age was 68; 72% had an Eastern Cooperative Oncology Group performance status ≥3. The median timing of PC access was 9 days (first interquartile = 3, third interquartile = 19). The use of analgesics (from 75% to 85%, p = 0.001) and opioids (from 50% to 73%, p < .001) increased. A lower proportion was receiving antibiotics (68% vs 48%, p < 0.001), thromboprophylaxis (44% vs 26%, p < 0.001), antihypertensives (28% vs 15%, p = 0.001), and antiemetic agents (64% vs 54%, p = 0.027). Chemotherapy use was lower (39–25%, p < 0.001). More patients had an end-of-life preference (39% to 25%, p < 0.001) and were not willing to receive intubation (32% vs 60%, p < 0.001), intensive care treatment (30% vs 55%, p < 0.001), cardiopulmonary resuscitation (35% vs 62%, p < 0.001), and artificial nutrition (22% vs 34%, p < 0.001).

Significance of results

Although PC referrals occurred exceedingly late during the cancer disease trajectory, positive changes were observed in medication profiles, clinical interventions use, and end-of-life preferences of patients with advanced cancer referred to a specialized inpatient PC consultation team in Brazil. Further efforts are needed to improve early palliative cancer care in developing countries.

Keywords

Palliative careQuality of lifeTreatment outcomes
Type
Original Article
Information
Palliative & Supportive Care , Volume 17 , Issue 4 , August 2019 , pp. 425 - 430
Copyright
Copyright © Cambridge University Press 2018 

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