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DOI: 10.5935/2526-8732.20220344
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 Financial support: None to declare.
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.
Publikationsverlauf
Eingereicht: 10. April 2022
Angenommen: 04. Oktober 2022
Artikel online veröffentlicht:
20. Oktober 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/)
Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil
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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