Palliative Care Unit and Clinical Oncology Department, Barretos Cancer Hospital, Rua Antenor Duarte Vilella, 1331 Bairro Dr. Paulo Prata, Barretos, São Paulo, Brazil.
Eur J Cancer Care (Engl). 2012 Jan;21(1):124-30. doi: 10.1111/j.1365-2354.2011.01298.x. Epub 2011 Nov 2.
The focuses of palliative care are to provide symptom relief and improve quality of life through an interdisciplinary approach. Previous studies conducted to evaluate the effectiveness of palliative care in reducing symptom distress among outpatients confirmed the importance of the palliative care approach. To our knowledge, there is no published information from Brazil regarding the impact of a palliative care outpatient programme in reducing symptom distress. Symptom scores from 232 patients were measured using Edmonton Symptom Assessment System scales in two consecutive consults. Changes in symptoms at follow-up visit were analysed using Wilcoxon signed-rank paired test. The symptom subtraction indices (SSI) (follow-up scores minus baseline scores) were calculated and then analysed with Spearman's correlation. Edmonton Symptom Assessment System median scores at follow-up visits were statistically significant reduced in all symptoms evaluated. All the SSI positively correlated with well-being-SSI. Other important SSI correlations were: fatigue-SSI and anxiety-SSI, and fatigue-SSI and dyspnoea-SSI. Our palliative care outpatient programme was able to provide a significant improvement in the symptoms evaluated. The well-being-SSI was positively correlated with all the SSI, verifying that the control of symptoms in palliative care is essential for the patient well-being. Adequate/inadequate control of specifically symptoms seems to indirectly improve/worsen other symptoms.
缓和医疗的重点是通过跨学科的方法提供症状缓解和提高生活质量。之前进行的评估缓和医疗对减少门诊患者症状困扰的有效性的研究证实了缓和医疗方法的重要性。据我们所知，巴西没有关于缓和医疗门诊计划在减少症状困扰方面的影响的公开信息。在两次连续就诊中，使用埃德蒙顿症状评估系统量表测量了 232 名患者的症状评分。使用 Wilcoxon 符号秩配对检验分析随访时症状的变化。计算症状减分指数（SSI）（随访评分减去基线评分），然后用 Spearman 相关分析进行分析。在所有评估的症状中，随访时埃德蒙顿症状评估系统的中位数评分均有统计学显著降低。所有 SSI 与幸福感 SSI 呈正相关。其他重要的 SSI 相关性包括：疲劳 SSI 和焦虑 SSI，以及疲劳 SSI 和呼吸困难 SSI。我们的缓和医疗门诊计划能够显著改善评估的症状。幸福感 SSI 与所有 SSI 呈正相关，这证实了在缓和医疗中控制症状对患者的幸福感至关重要。特定症状的适当/不适当控制似乎会间接地改善/恶化其他症状。
