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.
Key Words
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Article Info
Publication History
Published online: August 23, 2019
Accepted:
August 15,
2019
Identification
Copyright
© 2019 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
