Parreiras Fernanda Cardoso, Drummond-Lage Ana Paula, de Souza Brandão Marina Patrus Ananias, Silva Laura Nogueira, Geo Lara Salvador, Andrade Brenda Bhering, de Melo Andreia Cristina, Wainstein Alberto Julius Alves
Medical Science Minas Gerais (CMMG), Belo Horizonte, Brazil.
National Cancer Institute (INCA), Rio de Janeiro, Brazil.
Int J Cancer Med. 2024;7(1):28-34. Epub 2024 Mar 18.
Despite enormous recent advances in stage IV melanoma treatment, it continues to have a significant mortality. Five-years survival is below 50% even when granted full access to effective therapeutic regimens. Considering the real world, mostly with low or medium-income countries like Brazil, where 75% of population depends on public health system receiving ineffective Dacarbazine chemotherapy, more than 95% of stage IV patients are dead before 5 years. Knowing the survival process of melanoma end-of-life time is imperative to help physicians to establish better symptoms control and improve the quality of death of these patients.
Relative caregiver of melanoma end of life patients were invited to participate in a specific interview answering questions for the purpose of gathering information regarding symptoms and patients' complaints at the last 30 days, 7 days and at the day of death.
Although melanoma has a highest propensity for brain dissemination, seizure and focal neurological deficits were not a major complaint. Most of dying melanoma symptoms are shared among other solid terminality tumor process and get worse from 30 days to 7 days, but the majority of symptoms kept unchanged from 7 days till time to death. Wound bleeding and bad odor were the only complaints that got worse during the whole terminality process and could be improved with better commitment of assistant team.
although a strong effort is made to control brain metastasis, local and regional open wound metastasis represents a major remediable complaint that should receive more attention at end-of-life melanoma patients.
尽管近期IV期黑色素瘤治疗取得了巨大进展，但它的死亡率仍然很高。即使能充分使用有效的治疗方案，五年生存率仍低于50%。考虑到现实世界，主要是像巴西这样的中低收入国家，75%的人口依赖公共卫生系统接受无效的达卡巴嗪化疗，超过95%的IV期患者在5年内死亡。了解黑色素瘤终末期的生存过程对于帮助医生更好地控制症状和提高这些患者的死亡质量至关重要。
邀请黑色素瘤终末期患者的亲属参与特定访谈，回答问题，以收集有关患者在最后30天、7天及死亡当天的症状和主诉信息。
尽管黑色素瘤最易发生脑转移，但癫痫发作和局灶性神经功能缺损并非主要主诉。大多数黑色素瘤临终症状与其他实体性终末期肿瘤过程相同，从30天到7天会加重，但大多数症状从7天到死亡时保持不变。伤口出血和异味是整个终末期过程中唯一加重的主诉，通过辅助团队更好的投入可以得到改善。
尽管在控制脑转移方面付出了巨大努力，但局部和区域性开放性伤口转移是一个主要的可补救的主诉，在黑色素瘤终末期患者中应受到更多关注。
