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Valentino TCDO, de Oliveira MA, Paiva CE, Paiva BSR. Where do Brazilian cancer patients prefer to die? Agreement between patients and caregivers. J Pain Symptom Manage 2022; 64:186-204. [PMID: 35398168 DOI: 10.1016/j.jpainsymman.2022.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/16/2022] [Accepted: 03/24/2022] [Indexed: 11/29/2022]
Abstract
Preferred place-of-death (PPoD) is considered an important outcome for the development of appropriate models of care and for improving health policies in countries with underdeveloped palliative care (PC) OBJECTIVES: To determine the concordance between the PPoD of a sample of Brazilian seriously-ill cancer patients and their caregivers, and its associated factors under four different end-of-life (EOL) scenarios: 1) health deterioration in the overall context; 2) health deterioration with severe and uncomfortable symptoms; 3) health deterioration receiving home-based visits as needed; 4) health deterioration receiving home-based visits as needed, when suffering severe and uncomfortable symptoms METHODS: Cross-sectional study at a large Brazilian cancer center, between February 2019 and July 2021. 190 adult cancer patients and their caregivers (n = 190) were analyzed RESULTS: Patient and/or caregiver PPoD concordance for EOL scenario one: 64% vs. 43% for death at home, 22% vs. 30% for death in a PC unit, 14% vs. 27% for death in hospital. Higher patient and/or caregiver PPoD concordance was found for death in hospital (41%; 49%) in EOL scenario two, and for death at home for scenario three (77%; 74%). Agreement coefficient was moderate for scenario two (k = 0.430; P < 0.001), and fair for EOL scenarios one, three and four (k = 0.237, P < 0.001; k = 0.296, P < 0.001; k = 0.307, P < 0.001, respectively). Associated disagreement factors were: performance status (OR:3.03), self-perceived health (OR: 6.99), marital status (OR:2.92), and hospital and/or emergency room proximity (OR:4.11). The presence of relevant persons (42.3% vs. 44.2%), followed by spirituality (38.5% vs. 27.9%) and the place-of-death (14.0% vs. 18.4%), were the most important factors in the EOL, when comparing patients and care givers opinions, respectively CONCLUSION: Low agreement between patients and caregivers on PPoD was identified. EOL clinical factors and deterioration, and PC support seem to influence PPoD.
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Affiliation(s)
- Talita Caroline de Oliveira Valentino
- Oncology Graduate Program (T.C.D.O.V, C.E.P., B.S.R.P.), Barretos Cancer Hospital, Barretos, São Paulo, Brazil; Research Group on Palliative Care and Health-Related Quality of Life (GPQual) (T.C.O.V., M.A.D.O., C.E.P., B.S.R.P.), Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Marco Antonio de Oliveira
- Research Group on Palliative Care and Health-Related Quality of Life (GPQual) (T.C.O.V., M.A.D.O., C.E.P., B.S.R.P.), Barretos Cancer Hospital, Barretos, São Paulo, Brazil; Researcher Support Center, Learning and Research Institute (M.A.D.O., C.E.P., B.S.R.P.), Barretos Cancer Hospital, Barretos, SP, Brazil
| | - Carlos Eduardo Paiva
- Oncology Graduate Program (T.C.D.O.V, C.E.P., B.S.R.P.), Barretos Cancer Hospital, Barretos, São Paulo, Brazil; Research Group on Palliative Care and Health-Related Quality of Life (GPQual) (T.C.O.V., M.A.D.O., C.E.P., B.S.R.P.), Barretos Cancer Hospital, Barretos, São Paulo, Brazil; Researcher Support Center, Learning and Research Institute (M.A.D.O., C.E.P., B.S.R.P.), Barretos Cancer Hospital, Barretos, SP, Brazil; Department of Clinical Oncology, Breast and Gynecology Division (C.E.P.), Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Bianca Sakamoto Ribeiro Paiva
- Oncology Graduate Program (T.C.D.O.V, C.E.P., B.S.R.P.), Barretos Cancer Hospital, Barretos, São Paulo, Brazil; Research Group on Palliative Care and Health-Related Quality of Life (GPQual) (T.C.O.V., M.A.D.O., C.E.P., B.S.R.P.), Barretos Cancer Hospital, Barretos, São Paulo, Brazil; Researcher Support Center, Learning and Research Institute (M.A.D.O., C.E.P., B.S.R.P.), Barretos Cancer Hospital, Barretos, SP, Brazil.
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Mourão TC, Curado MP, de Oliveira RAR, Santana TBM, Favaretto RDL, Guimarães GC. Epidemiology of Urological Cancers in Brazil: Trends in Mortality Rates Over More Than Two Decades. J Epidemiol Glob Health 2022; 12:239-247. [PMID: 35639266 PMCID: PMC9470798 DOI: 10.1007/s44197-022-00042-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 05/09/2022] [Indexed: 11/29/2022] Open
Abstract
Background Considering the socioeconomic disparities and inequalities observed in the healthcare resources among the Brazilian regions, we aimed to analyze the mortality trends of urological cancers in Brazil to identify areas with differential risks. Methods Deaths related to prostate (PCa), bladder (BCa), kidney (KC), penile (PeC), and testis (TCa) cancers from 1996 to 2019 were retrieved from the Mortality Information System database (Brazil). Geographic and temporal patterns were analyzed using age-standardized mortality rates (ASMRs). A joinpoint regression model was used to identify changes in the trends and calculate the average annual percentage change (AAPC) for each region. Results In Brazil, the ASMRs (per 100,000 persons/year) were 11.76 for PCa; 1.37, BCa; 1.13, KC; 0.33, and PeC; 0.26, TCa over the period. Increasing mortality trends were registered for BCa (AAPC = 0.45 in men; 0.57 in women), KC (AAPC = 2.03 in men), PeC (AAPC = 1.01), and TCa (AAPC = 2.06). The PCa mortality presented a significant reduction after 2006. The Northeast and North regions showed the highest increases in the PCa mortality. The South registered the highest ASMRs for BCa and KC, but the highest increasing trends occurred in the men from the Northeast. The North presented the highest ASMR for PeC, while the South registered the highest ASMR for TCa. Conclusion Differences among regions may be partly explained by disparities in the healthcare systems. Over the study period, the North and Northeast regions presented more discrepant mortality rates. Efforts should be made to ensure access to the healthcare resources for people at risk, particularly in these regions. Supplementary Information The online version contains supplementary material available at 10.1007/s44197-022-00042-8.
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Affiliation(s)
- Thiago Camelo Mourão
- Department of Uro-Oncology, BP-A Beneficência Portuguesa de São Paulo, São Paulo, Brazil. .,Graduate School, Fundação Antônio Prudente, ACCamargo Cancer Center, R. Prof. Antônio Prudente, 211, São Paulo, 01509-010, Brazil.
| | - Maria Paula Curado
- Department of Statistics and Epidemiology, International Research Center, ACCamargo Cancer Center, São Paulo, Brazil
| | | | - Thiago Borges Marques Santana
- Department of Uro-Oncology, BP-A Beneficência Portuguesa de São Paulo, São Paulo, Brazil.,Division of Urology, ACCamargo Cancer Center, São Paulo, Brazil
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Lombardo MS, Popim RC. Access of the patient to the cancer network under the “Sixty-Day Law”: Integrative Review. Rev Bras Enferm 2020; 73:e20190406. [DOI: 10.1590/0034-7167-2019-0406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 11/25/2019] [Indexed: 12/24/2022] Open
Abstract
ABSTRACT Objectives: to analyze Brazilian scientific production on patient access to the oncology network under the “Sixty-Day Law”. Methods: integrative review of the literature in the databases Lilacs, PubMed and Scielo. The descriptors used were: neoplasms, health services accessibility, early detection of cancer. Articles published from 2015 to March 2019 were included. Results: 17 articles were analyzed and four themes emerged: inequality in access; qualification of Primary Care professionals; time as a determinant factor; information system as limiting factor. Conclusions: the access to the oncology network is unequal and there are several barriers faced by the users. A continuing education of health professionals is necessary to implement preventive strategies. Treatment initiation is late, showing non-compliance with the law. The health care network is highly fragmented, there is lack of coordination between the services and, consequently, there is a lack of patient follow-up.
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de Oliveira Valentino TC, Paiva CE, Hui D, de Oliveira MA, Ribeiro Paiva BS. Impact of Palliative Care on Quality of End-of-Life Care Among Brazilian Patients With Advanced Cancers. J Pain Symptom Manage 2020; 59:39-48. [PMID: 31449844 DOI: 10.1016/j.jpainsymman.2019.08.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 08/14/2019] [Accepted: 08/15/2019] [Indexed: 12/25/2022]
Abstract
CONTEXT Many patients with advanced cancer experience aggressive care during the end of life (EOL). Several studies have evaluated the benefits of palliative care (PC) on the reduction of aggressive measures; however, limited data are available about their benefit in Brazilian patients. OBJECTIVES To evaluate the impact of PC on the reduction of aggressive measures at the EOL. METHODS Longitudinal study analyzed retrospectively medical records of patients who died of advanced cancer from 2010 to 2014. Data were obtained on PC referral and five quality-of-care indicators at the EOL; that is, emergency department visits, hospital admission, intensive care unit admission, use of systemic antineoplastic therapy within the last 30 days of life, and place of death in hospital as well as the use of a composite score for aggressiveness of care. RESULTS Of the 1284 patients, 832 (65%) received some aggressive measures in EOL care. Over the years, there was a reduction in the aggressiveness of care (score = 0: 33.2% vs. 47.1%; P < 0.001). Patients not seen by PC received greater aggressive care compared with patients consulted by PC (score ≥1: 87.4% vs. 52.8%; P < 0.001). Early PC was associated with less chemotherapy (P = 0.001) and fewer emergency department visits (P = 0.004) in the last 30 days of life, when compared with late PC. However, there were no demonstrated benefits to significantly reduce the composite score at EOL care aggressiveness. CONCLUSION Patients with an advanced cancer consultation by PC staff received less aggressive care at the EOL when compared with patients without PC.
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Affiliation(s)
| | - Carlos Eduardo Paiva
- Research Group on Palliative Care and Health-Related Quality of Life (GPQual), Barretos Cancer Hospital, Barretos, São Paulo, Brazil; Oncology Graduate Program, Barretos Cancer Hospital, Barretos, São Paulo, Brazil; Department of Clinical Oncology, Breast and Gynecology Division, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - David Hui
- Department of Palliative Care and Rehabilitation Medicine, M.D. Anderson Cancer Center, The University of Texas, Houston, Texas, USA
| | - Marco Antonio de Oliveira
- Research Group on Palliative Care and Health-Related Quality of Life (GPQual), Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Bianca Sakamoto Ribeiro Paiva
- Research Group on Palliative Care and Health-Related Quality of Life (GPQual), Barretos Cancer Hospital, Barretos, São Paulo, Brazil; Oncology Graduate Program, Barretos Cancer Hospital, Barretos, São Paulo, Brazil.
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