Dados da vida real de uma enfermaria de oncologia em um hospital universitário brasileiro

Abstract

OBJECTIVE: Analyze data regarding patients in need of hospital care admitted in our oncology in?rmary aiming for better clinical practices, clinical support and scope for ?nancial and structural needs for institutions. METHODS: A prospective study of 191 patients admitted for in-hospital care during a year, who were strati?ed by diagnosis, age, sex, admission reason, duration of stay, re-admission rate and outcomes. RESULTS: 97 male and 94 female patients were admitted, with a 61-year-old mean age; the mean stay was 13,4 days; and a re-admission rate of 9,4%. Main admission causes: terminality [de?ned by PSECOG=4, with a 30 day or less estimated life expectancy]: 30 patients (15,7%); total pain: 23 (12,0%); oncological emergencies [febrile neutropenia, malignant hypercalcemia, medullar compression, superior vena cava syndrome]: 20 (10,4%); clinical deterioration [de?ned as worsening of patients performance or malnutrition]: 15 (7,8%); abdominal pain [without acute abdomen]: 14 (7,3%). Most common primary tumor sites were: colorectal=30 (15,7%), breast=28 (14,6%), stomach=20 (10,4%), lung=14 (7,3%), ovary=12 (6,2%) and prostate=10 (5,2%). RESULTS: 99 deaths (mortality rate 52,1%). Patients in terminality presented a 90% ratio of mortality within an average of 6,6 days of hospital care. Febrile neutropenia (42,8%) and abdominal pain (35,7%) both achieved above expected mortality rates. 91 patients were discharged from the hospital and went back to ambulatory care. CONCLUSION: Our analysis pointed at an admission rate of 1,2%, pointing at good clinical ambulatory practices. The mean in-hospital stay comparison between patients who were discharged and those who died, not considered terminal ill, was unexpectedly similar, 11,7 versus 13,4 days, respectively, suggesting that in-hospital care should be focused on symptoms - not outcomes. Patients with febrile neutropenia and gastrointestinal cancer should be evaluated with caution due to higher than expected mortality rates