Predictive factors of death on hospitalization in patients with advanced cancer in palliative care

Abstract

Prognostic assessment is essential to plan the care of patients with advanced cancer in palliative care. Objective: Thus, this study aims to assess the predictors of death in inpatients with advanced cancer in palliative care. Methods: This is a clinical, observational cohort study with patients aged >20 years, of both genders, evaluated within 48 hours of the first hospitalization. The independent variables were tumor location, nutritional risk [through the Patient-Generated Subjective Global Assessment (PG-SGA) short form], laboratory tests [C-reactive protein and albumin] and Karnofsky Performance Status (KPS). Logistic regression analyses were performed. Results: Eighty-two patients were evaluated, whose mean age was 61.8 (+ 13.2) years. Forty-nine (59.8%) patients died during hospitalization, among which the majority had KPS of 30-40% (p-value ¼ 0.043), higher means of the total score of the PG-SGA (p-value ¼ 0.050) and lower serum albumin concentrations (p-value ¼ 0.011). According to the multivariate model, tumor location in the gastrointestinal (GI) tract (OR: 1.73; 95% CI: 1.57-1.94), 30-40% KPS (OR: 1.29; 95% CI: 1.07-1.63) and albumin concentrations <3.5 g/dL (OR: 4.65; 95% CI: 1.22-17.7) were independent factors associated with an increased chance of death from hospitalization. Conclusion: Presenting an advanced tumor with localization in the GI tract, KPS 40% and serum albumin concentration <3.5 g/dL at admission were predictors of death in inpatients under palliative care.

Palliative care is defined by the World Health Organization (WHO)1 as an approach that aims to improve the quality of life of patients and their families in the face of a disease that threatens the continuity of life, through the prevention and relief of suffering, identification assessment, assessment and treatment of pain and other physical, psychosocial and spiritual symptoms. Early palliative care reduces unnecessary hospita lizations and the use of health services, contributing to efficient use of resources.2 In patients with advanced cancer in palliative care, the use of prognostic measures/markers assumes a guiding role in the estab lishment of care planning, contributing to the improvement of treatment strategies and the efficient use of available resources. Prognostic assessment minimizes the risk of undertreatment or futile and disproportionate therapies in advancing cancer.3 And, among the various predictors of survival, reduced functional capacity, exacerbated systemic inflammation and impaired nutri tional status, among others, have been described in the literature as useful prognostic indicators in clinical practice.4-6 Considering the role of prognostic evaluation in establishing the care and assistance plan for patients in palliative oncology care, it is extremely important to recognize the determinants of unfavorable clinical outcomes. Thus, this study aims to assess the factors associated with death in patients with advanced cancer, admitted to an exclusive Palliative Care Unit (PCU)