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CC BY 4.0 · Brazilian Journal of Oncology 2022; 18: e-20220344
DOI: 10.5935/2526-8732.20220344
Original Article
Clinical Oncology

Prognostic factors in inpatients with advanced cancer at a palliative care unit

Fatores prognósticos em pacientes internados com câncer avançado em uma unidade de cuidados paliativos
Karla Santos da Costa Rosa 
1   José Alencar Gomes da Silva National Cancer Institute (INCA), Palliative Care Unite - Rio de Janeiro - RJ - Brazil
,
Amanda Soares Oliveira
1   José Alencar Gomes da Silva National Cancer Institute (INCA), Palliative Care Unite - Rio de Janeiro - RJ - Brazil
,
Raphael de Paiva Cypriano
1   José Alencar Gomes da Silva National Cancer Institute (INCA), Palliative Care Unite - Rio de Janeiro - RJ - Brazil
,
Livia Costa de Oliveira
1   José Alencar Gomes da Silva National Cancer Institute (INCA), Palliative Care Unite - Rio de Janeiro - RJ - Brazil
› Author Affiliations Financial support: None to declare.
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ABSTRACT

Objectives: This study aims to identify prognostic factors and their discriminatory ability in inpatients with advanced cancer at a palliative care unit (PCU).

Material and Methods: Observational, prospective cohort study involving advanced cancer patients (October 2019 to May 2021) of their first admission to a PCU. Sociodemographic, clinical, functional, nutritional, and laboratory variables were evaluated. The outcome was death within 30 days. Kaplan-Meier curves, log-rank test, and Cox proportional hazard model were used to assess prognostic value. The C-statistic was used to test the predictive accuracy of the variables.

Results: Among 136 patients, 77 (56.6%) died within 30 days and the median overall survival was 10 (interquartile range: 6-14) days. The variables of 30-day mortality were tumor in the gastrointestinal tract (GIT) (hazard ratio [HR]: 1.61, 95% confidence interval [CI]: 1.11-2.82), impaired functionality (HR: 1.73, 95%CI: 1.09-3.00), nutritional risk (HR: 4.58, 95%CI: 1.62-12.92), and albumin <3g/dL (HR: 1.88, 95%CI: 1.05-3.34). However, albumin presented acceptable discrimination, with a C-statistic value of 0.75.

Conclusion: Inpatients with advanced cancer in the GIT, impaired functionality, reduced serum albumin, and at nutritional risk have a worse prognosis. Albumin concentration has better discriminatory ability than the other factors identified.

RESUMO

Objetivos: Este estudo tem como objetivo identificar fatores prognósticos e sua capacidade discriminatória em pacientes com câncer avançado internados em uma unidade de cuidados paliativos (UCP).

Material e Métodos: Estudo observacional de coorte prospectivo envolvendo pacientes com câncer avançado (outubro de 2019 a maio de 2021) de sua primeira admissão em uma UCP. Foram avaliadas variáveis sociodemográficas, clínicas, funcionais, nutricionais e laboratoriais. O desfecho foi a morte em 30 dias. Curvas de Kaplan-Meier, teste de logrank e modelo de risco proporcional de Cox foram usados para avaliar o valor prognóstico. A estatística-C foi utilizada para testar a acurácia preditiva das variáveis.

Resultados: Entre 136 pacientes, 77 (56,6%) morreram em 30 dias e a sobrevida global mediana foi de 10 (intervalo interquartil: 6-14) dias. As variáveis de mortalidade em 30 dias foram tumor no trato gastrointestinal (TGI) (taxa de risco [HR]: 1,61, intervalo de confiança de 95% [IC]: 1,11-2,82), funcionalidade prejudicada (HR: 1,73, IC95%: 1,09 -3,00), risco nutricional (HR: 4,58, IC95%: 1,62-12,92) e albumina <3g/dL (HR: 1,88, IC95%: 1,05-3,34). No entanto, a albumina apresentou discriminação aceitável, com valor da estatística-C de 0,75.

Conclusão: Pacientes internados com câncer avançado no TGI, funcionalidade prejudicada, albumina sérica reduzida e em risco nutricional apresentam pior prognóstico. A concentração de albumina tem melhor capacidade discriminatória do que os outros fatores identificados.

Keywords:

Neoplasms - Palliative care - Prognosis - Hospitalization - Mortality

Palavras-chave:

Neoplasias - Cuidado paliativo - Prognóstico - Hospitalização - Mortalidade


Publication History

Received: 10 April 2022

Accepted: 04 October 2022

Article published online:
20 October 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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Bibliographical Record
Karla Santos da Costa Rosa, Amanda Soares Oliveira, Raphael de Paiva Cypriano, Livia Costa de Oliveira. Prognostic factors in inpatients with advanced cancer at a palliative care unit. Brazilian Journal of Oncology 2022; 18: e-20220344.
DOI: 10.5935/2526-8732.20220344
 

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