Dados do Trabalho

Título

IMPACT OF OUTPATIENT CARE PROVIDED BY A PALLIATIVE CARE TEAM ON SURVIVAL AND QUALITY OF END-OF-LIFE CARE IN A PRIVATE ONCOLOGY CENTER IN BRAZIL

Introdução

Palliative care has shown improvement in the quality of life of cancer patients by improving symptomatic control and reducing overtreatment at the end of life (EOL).

Objetivo

Analyze the characteristics of patients followed by an outpatient palliative care team (OPCT) and the impact on the end-of-life outcomes and survival.

Método

We retrospectively retrieved data from electronic medical records of patients who died from cancer or associated complications during the year of 2020. They were divided into two groups: OPCT and No-OPCT. OPCT group was followed-up by a multidisciplinary team composed of physician, nurse, physiotherapist, psychologist, nutritionist, social worker, speech-language therapist, and pharmacist, who regularly evaluated cancer patients during their treatments at outpatient setting. We performed univariate and multivariate analysis by Cox proportional hazards model. Overall survival (OS) was analyzed using Kaplan-Meier and Log-rank test. P < 0,05 was deemed as statistically significant.

Resultado

A total of 315 patients were included: OPCT (N=122) and No-OPCT (N=193). Gastrointestinal and breast cancers were the most prevalent in both groups. Total home death was 64% in the OPCT group and 36% in the No-OPCT group (p<0,001). Admissions in intensive care unit in the last 30 days of life (ICU30) was smaller in OPCT (45%) compared to No-OPCT (55%), p=0,413. Likewise, patients treated with chemotherapy in the last 30 days of life (CT30) was 34% vs 66% patients (p=0,146). In multivariate analysis, follow-up by the OPCT was the strongest independent predictor of home death (OR=4,33, IC 95% 2,38-7,89, P<0,0001). Median OS of stage IV patients was similar in both groups (15,8 months vs 14,8 months; p=0,52).

Conclusão

Follow-up by an OPCT had a strong positive impact on the EOL of cancer patients, with no significant difference in OS. Our data highlights that follow-up by an OPCT may increase the probability of home death and reduce overtreatment at the EOL of cancer patients.

Palavras-chave

palliative care, cancer, end-of-life care, survival