Care for patients with advanced cancer in the last weeks of life in Brazil

ABSTRACT

Despite all advances in the treatment of neoplasms and substantial increases in fiveyear survival rates, most patients still die due to their diseases. Late diagnosis in some circumstances and resistance mechanisms throughout treatment still cause most patients to require palliative care integrated with cancer treatment, since diagnosis. Most palliative care interventions can and should be carried out by the oncologist, with reference to the multidisciplinary team specialized in palliative care in the most critical moments of clinical evolution. It is important that the oncologist develops their skills in this scenario and knows how to recognize the moment of referral. The following text outlines the basic skills that are expected of oncologists, such as recognition of the prognosis, identification and correct assessment of symptoms, definition of the time to stop antineoplastic therapy, how to communicate these aspects to patients and family, how to involve psychosocial and spiritual issues and, finally, how to stay within the limits established by modern bioethics. This work consists of brief recommendations for oncologists working in Brazil.

RESUMO

Apesar de todos os avanços no tratamento das neoplasias e aumentos substanciais nas taxas de sobrevida em cinco anos, a maioria dos pacientes ainda morre em decorrência de suas doenças. Diagnósticos tardios em algumas circunstâncias e mecanismos de resistência ao longo do tratamento ainda fazem com que a maioria dos pacientes necessite de cuidados paliativos integrados ao tratamento oncológico, desde o diagnóstico. A maioria das intervenções em cuidados paliativos pode e deve ser realizada pelo oncologista, tendo como referência a equipa multidisciplinar especializada em cuidados paliativos nos momentos mais críticos da evolução clínica. É importante que o oncologista desenvolva suas habilidades nesse cenário e saiba reconhecer o momento do encaminhamento. O texto a seguir descreve as habilidades básicas que são esperadas dos oncologistas, como reconhecimento do prognóstico, identificação e avaliação correta dos sintomas, definição do momento de interromper a terapia antineoplásica, como comunicar esses aspectos aos pacientes e familiares, como envolver questões psicossociais e espirituais e, por fim, como se manter dentro dos limites estabelecidos pela bioética moderna. Este trabalho consiste em breves recomendações para oncologistas atuantes no Brasil.

Headings:

Terminal care - Death - Palliative care - Palliative medicine

Descritores:

Cuidados terminais - Morte - Cuidado paliativo - Medicina paliativa

Publikationsverlauf

Eingereicht: 13. Oktober 2021

Angenommen: 26. November 2021

Artikel online veröffentlicht:
27. Januar 2022

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