Alcalde-Castro Mirza Jacqueline, Soto-Perez-de-Celis Enrique, Covarrubias-Gómez Alfredo, Sánchez-Román Sofía, Quiróz-Friedman Paulina, Navarro-Lara África, Ramos-Lopez Wendy Alicia, Moreno-García María Luisa, Contreras-Garduño Sergio, Perez-Montessoro Viridiana, Goss Paul E, Chávarri-Guerra Yanin
Department of Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
J Palliat Care. 2020 Jan;35(1):40-45. doi: 10.1177/0825859719834920. Epub 2019 Mar 24.
Early specialized palliative care improves quality of life of patients with advanced cancer, and guidelines encourage its integration into standard oncology care. However, many patients fail to obtain timely palliative/supportive care evaluations, particularly in limited-resource settings. We aimed to determine the proportion of patients with advanced cancer who received an assessment of symptoms and were referred to supportive and palliative care services during the first year after diagnosis in a Mexican hospital.
Individuals with newly diagnosed advanced solid tumors and 1 year of follow-up at the oncology clinics in the in Mexico City from October 2015 to April 2016 were included in this retrospective study.
Seventy-seven patients were included. Forty-two (54.5%) were referred to the various supportive care services during the first year after diagnosis, and 23 (29.8%) were referred to the palliative care clinic. The most commonly assessed symptoms by oncologists were pain (77.9%), anorexia (74.0%), fatigue (68.8%), and nausea (55.8%), while depression/anxiety were evaluated in 10 (12.9%) patients. The oncologist offered to clarify treatment goals in 39 (50.6%) cases and evaluated the understanding of diagnosis/illness and prognosis in 22 (28.5%).
Palliative and supportive care services were widely underutilized, which may be related to a lack of standardized symptom assessments and poor end-of-life communication. Novel strategies are needed to improve the implementation of tools for systematic symptom assessment and to optimize the integration of supportive care interventions into oncology care in developing countries.
早期专科姑息治疗可提高晚期癌症患者的生活质量，相关指南鼓励将其纳入标准肿瘤治疗。然而，许多患者未能及时获得姑息/支持性治疗评估，尤其是在资源有限的环境中。我们旨在确定在墨西哥一家医院确诊后的第一年中，接受症状评估并被转介至支持性和姑息治疗服务的晚期癌症患者比例。
本回顾性研究纳入了2015年10月至2016年4月在墨西哥城肿瘤诊所新诊断为晚期实体瘤且有1年随访期的患者。
共纳入77例患者。42例（54.5%）在确诊后的第一年被转介至各种支持性治疗服务，23例（29.8%）被转介至姑息治疗诊所。肿瘤学家最常评估的症状为疼痛（77.9%）、厌食（74.0%）、疲劳（68.8%）和恶心（55.8%），而10例（12.9%）患者接受了抑郁/焦虑评估。肿瘤学家在39例（50.6%）病例中提出明确治疗目标，在22例（28.5%）病例中评估了对诊断/疾病及预后的理解。
姑息和支持性治疗服务的利用率普遍较低，这可能与缺乏标准化症状评估及临终沟通不佳有关。需要新的策略来改善系统症状评估工具的应用，并优化发展中国家支持性治疗干预措施在肿瘤治疗中的整合。
