Dados do Trabalho

Título

END-OF-LIFE COST IN A CANCER PATIENTS IN A REFERENCE HOSPITAL IN SOUTHERN BRAZIL

Introdução

The high end-of-life cost of cancer patients may be associated with a worse quality of death and show an inadequate use of health resources. The assessment of hospital costs at the end of life of cancer patients may be useful for a better understanding of the quality of care and assistance.

Objetivo

This study aimed to define the cost of end-of-life healthcare and determinants for cancer patients during the last 30 days of life in a medical clinic ward of a public hospital.

Método

A population-based retrospective study was conducted with data from 109 cancer patients in a public hospital in Porto Alegre, from 01 Jan 2018 to 31 Dec 2019. Associations with spending per day were evaluated using the median regression model. All variables with p < 0.10 in the univariate analysis were included in the initial multivariate model, and later eliminated in stages until reaching a combination in which all presented p ≤ 0.05. Analyzes were performed using the R software.

Resultado

In this study, 54,1% of the 109 patients were female, and the average age of death was 69 (+/- DP 10). Among these, 65% of patients were regularly monitored by the oncology service of the institution and 22% received chemotherapy 30 days before death. Most (77%) had metastatic disease and only 17% had been diagnosed during their stay that led to death. Additionally, 8.3% were in the intensive care unit when they died. The median daily cost per patient was R$103.40. The highest total cost was related to the use of medications. Considering the last 30 days of hospitalization retrospectively, it was observed that from 30 to 15 days the median cost with medication was R$ 477.93 (p<0,001); from 15 to 5 days it was R$ 309,8 (p = 0,657); and in the last 5 days, it was R$266,92 (p = 0,657). The median medical graduation time of the medical team involved was 2 years and the internship time was 7 months. The description of therapy limitation in the medical record (found in 90.8% of the patients) reduced the cost of daily treatment by R$ 43.6 (median of reduction), adjusted for the medical resident formation time (p 0.038).

Conclusão

The median daily cost in end-of-life patients was $103.40. This cost is directly associated with potentially aggressive treatments and inversely with the medical resident training time. The description in the medical record of treatment limitations reduced hospital costs in end-of-life care.

Palavras-chave

cost, cancer, end-of-life