Soares Luiz Guilherme L, Gomes Renato Vieira, Japiassu André M
1 Department of Health Services and Costs, End of Life Care Study Group, Unimed Federação Rio de Janeiro, Rio de Janeiro, Brazil.
2 Research Laboratory of Intensive Care Medicine, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
Am J Hosp Palliat Care. 2019 Sep;36(9):775-779. doi: 10.1177/1049909119828086. Epub 2019 Feb 11.
Patients with hematologic malignancies (HMs) often receive poor-quality end-of-life care. This study aimed to identify trends in end-of-life care among patients with HM in Brazil. We conducted a retrospective cohort study (2015-2018) of patients who died with HM, using electronic medical records linked to health insurance databank, to evaluate outcomes consistent with health-care resource utilization at the end of life. Among 111 patients with HM, in the last 30 days of life, we found high rates of emergency department visits (67%, n = 75), intensive care unit admissions (56%, n = 62), acute renal replacement therapy (10%, n = 11), blood transfusions (45%, n = 50), and medical imaging utilization (59%, n = 66). Patients received an average of 13 days of inpatient care and the majority of them died in the hospital (53%, n = 58). We also found that almost 40% of patients (38%, n = 42) used chemotherapy in the last 14 days of life. These patients were more likely to be male (64% vs 22%; < .001), to receive blood transfusions (57% vs 38%; = .05), and to die in the hospital (76% vs 39%; = .009) than patients who did not use chemotherapy in the last 14 days of life. This study suggests that patients with HM have high rates of health-care utilization at the end of life in Brazil. Patients who used chemotherapy in the last 14 days of life were more likely to receive blood transfusions and to die in the hospital.
血液系统恶性肿瘤（HM）患者往往接受质量较差的临终关怀。本研究旨在确定巴西HM患者临终关怀的趋势。我们对死于HM的患者进行了一项回顾性队列研究（2015 - 2018年），使用与健康保险数据库相关联的电子病历，以评估与临终时医疗资源利用情况一致的结局。在111例HM患者中，在生命的最后30天里，我们发现急诊就诊率很高（67%，n = 75）、重症监护病房收治率（56%，n = 62）、急性肾替代治疗率（10%，n = 11）、输血率（45%，n = 50）以及医学影像使用率（59%，n = 66）。患者平均接受了13天的住院治疗，其中大多数在医院死亡（53%，n = 58）。我们还发现，近40%的患者（38%，n = 42）在生命的最后14天使用了化疗。与在生命的最后14天未使用化疗的患者相比，这些患者更有可能是男性（64%对22%；P <.001）、接受输血（57%对38%；P =.05）以及在医院死亡（76%对39%；P =.009）。这项研究表明，巴西HM患者在临终时医疗资源利用率很高。在生命的最后14天使用化疗的患者更有可能接受输血并在医院死亡。
