Tripodoro Vilma A, Llanos Victoria, De Lellis Silvina, Salazar Güemes Cecilia, De Simone Gabriel G, Gómez-Batiste Xavier
Instituto de Investigaciones Médicas Alfredo Lanari, Universidad de Buenos Aires, Argentina. E-mail:
Instituto Pallium Latinoamérica, Buenos Aires, Argentina.
Medicina (B Aires). 2019;79(2):95-103.
The early identification of patients with palliative needs has shown benefits in terms of quality of life and treatment goals. No prospective methods have been applied in Argentina to identify palliative needs in cancer patients. The NECPAL tool combines the physician's own insight with objective indicators of disease progression and indicators of chronic advanced conditions. The aim of this study was to identify prognostic factors of mortality in hospitalized and ambulatory patients with cancer and palliative needs according to the NECPAL tool in a University Hospital in Buenos Aires city. Study variables were obtained by interviews with 10 physicians in charge of 317 patients with cancer over a 2-year follow-up period. A total of 183 patients with palliative needs were labelled as NECPAL+. Of these, 137 died after a median 4-month follow-up period. The death rate was 11% patients/month. The mortality was higher in inpatients during the first month (p < 0.003). In the multivariate model, the best predictors of mortality combining relevant indicators were: inpatients (HR 1.87; 95% CI 1.24-2.84; p = 0.003), initial diagnosis other than breast cancer (HR 2.04; 95% CI 1.23-3.40; p = 0.006), metastatic disease (HR 1.67; 95% CI 1.15-2.42; p = 0.007), functional deterioration (HR 1.95; 95% CI 1.28-2.97; p = 0.002), and malnutrition (HR 1.53; 95% CI 1.04-2.23; p = 0.02 9). The major breakthrough was the systematic prospective identification of palliative needs in cancer patients for the first time in Argentina. The NECPAL tool can improve the prediction of mortality in hospital settings.
对有姑息治疗需求的患者进行早期识别已显示出在生活质量和治疗目标方面的益处。在阿根廷，尚未应用前瞻性方法来识别癌症患者的姑息治疗需求。NECPAL工具将医生自身的洞察力与疾病进展的客观指标以及慢性晚期病症的指标相结合。本研究的目的是根据NECPAL工具，在布宜诺斯艾利斯市的一家大学医院中，识别住院和门诊癌症患者及有姑息治疗需求患者的死亡预后因素。研究变量是通过对负责317例癌症患者的10名医生进行访谈获得的，随访期为2年。共有183例有姑息治疗需求的患者被标记为NECPAL+。其中，137例在中位4个月的随访期后死亡。死亡率为每月11%的患者。住院患者在第一个月的死亡率更高（p<0.003）。在多变量模型中，结合相关指标的死亡率最佳预测因素为：住院患者（HR 1.87；95%CI 1.24 - 2.84；p = 0.003）、非乳腺癌的初始诊断（HR 2.04；95%CI 1.23 - 3.40；p = 0.006）、转移性疾病（HR 1.67；95%CI 1.15 - 2.42；p = 0.007）、功能恶化（HR 1.95；95%CI 1.28 - 2.97；p = 0.002）和营养不良（HR 1.53；95%CI 1.04 - 2.23；p = 0.029）。主要突破是在阿根廷首次系统地前瞻性识别癌症患者的姑息治疗需求。NECPAL工具可改善医院环境中死亡率的预测。
