Indicatives of palliative care in patients with lung cancer treated in the Brazilian public health system.

Abstract

e24007 Background: In the last decade, a growing body of evidence has demonstrated that palliative care improves outcomes such as QOL, symptom burden, survival and decreases resource utilization. However, many patients eligible for PC are not referred to it or receive these services only in the last phase of their illness. Significant barriers explain the lack of access to PC, including identifying patients who would benefit from this approach. The aim of this study is to identify indicatives of palliative care in patients with lung cancer in Brazil in order to improve access. Methods: Prospective non-concurrent cohort carried out from a database developed through probabilistic and deterministic linkage of data from information systems of the Brazilian Public Health System. Study population was composed of all patients who started cancer treatment between 2009 and 2014 and who was hospitalized at least one time after starting treatment. To address the indication for palliative care, patients whose death occurred within one year after the first hospitalization were selected. Logistic regression models were used to assess the association between death in one year and sociodemographic, clinical and treatment-related variables. Results: A total of 27,634 patients diagnosed with lung cancer started cancer treatment in that period and 17,805 (64%) died one year after the first hospitalization. Among the deceased patients, the median age was 63 years, 59,8% of them were in stage IV, 32.4% in stage III and the majority received chemotherapy as their first treatment (72,3%). In this sub-group, 44,3% lived in the southeastern region of the country and 63,3% were male. Furthermore, 91% of the patients required emergency hospitalization and 20,1% were admitted in ICU units. The multivariate analysis revealed that being male (OR=1.2; CI, 1.13-1.28), live in the north region (OR=1.38, CI, 1.13-1.69) and having an older age (40-59 years, OR= 1.32; CI, 1.07-1.63; 60-79 years, OR=1.48; CI, 1.2-1.83; 80 or more years, OR=1.62; CI, 1.26-2.08) were associate with the outcome. Patients that were diagnosed with stage IV lung cancer (OR=1.99; CI, 1.7-2.33) and those who received radiotherapy (OR=7.83; CI, 6.86-8.94) as first treatment presented higher odds of dying in one year after the first hospitalization. In addition, patients who were hospitalized on an emergency basis (OR=10.94; CI, 10.19-11.74) and those who were admitted in ICU units (OR= 1.17; CI; 1.07-1.26) had higher association with the outcome. Interestingly, patients that took more than 60 days to initiate cancer treatment (OR=0.69; CI, 0.64-0.74) presented lower association with dying in one year. Conclusions: Our study demonstrates variables that can be used to identify patients who may benefit most from PC. Moreover, this indicatives can be easily assessed in the moment of hospitalization.