Impacts of an outpatient palliative care team on the end-of-life care at a cancer center in Brazil.

Le résumé fourni par la source

231 Background: It has been demonstrated. that early palliative care improves the quality of life of cancer patients by reducing overtreatment at the end-of-life (EoL) and improving symptomatic control. However, there is a lack of research on the impact of palliative care on the EoL outcomes in developing countries. EoL cancer care varies widely and very few centers evaluate it systematically. Studies suggest that people often prefer dying at home, however, data also shows that most deaths in Latin America occur at hospitals. Methods: This study aimed to analyze the impact of cancer patients’ follow-up by an outpatient palliative care team (OPCT) on the EoL outcomes at a private Multicentric Cancer Center in Brazil. Data were retrospectively retrieved from electronic medical records of patients who were treated at a Brazilian Cancer Center and who died between January 2022 and December 2022. Adults with any type of cancer were considered eligible. The participants were divided into two groups: the OPCT group was followed up by a palliative care multidisciplinary team who regularly evaluated cancer patients during their treatments in an outpatient setting and the No-OPCT group followed up by oncologists with multidisciplinary teams as demanded. Univariate comparisons and multivariate analysis adjusted to the multivariate logistic regression model were performed and p<0.05 was deemed as statistically significant. Results: A total of 1980 patients were included in the study: OPCT (N=640) and No-OPCT (N=1340). Most of the patients in both groups were older than 65 years (61% vs 66%). The groups were well balanced concerning gender (women: 54% vs 46%), and TNM stage (stage IV: 87% vs 89%). Gastrointestinal and breast cancers were the most prevalent in both groups. The rate of home death was 20.2% in the OPCT group, compared to 10.6% in the No-OPCT group, meaning a 2 times greater chance of dying at home when the OPCT was provided (p<0.001). In multivariate analysis, follow-up by the OPCT was the strongest independent predictor of home death. Age, gender, and TNM stage did not influence the place of death. Conclusions: The current study suggests that an active palliative care program in an outpatient care institution, through early conversations about goals of care, prognostic awareness, and EoL preferences may potentially improve the EoL outcomes for patients with cancer, while also reinforcing the need of early referral for a palliative care team. Future studies and ongoing prospective studies in Brazil are needed to validate these findings and also to evaluate the impact of other variables, such as health support systems for home deaths.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.