Validación de un modelo pronóstico de supervivencia basado en parámetros biológicos para pacientes con cáncer terminal atendidos en ámbito domiciliario

Abstract

IntroductionHome care is a health care service that is in increasing demand for terminally ill patients. Knowing survival time would help health care teams to develop appropriate care plans, and to deal with ethical dilemmas. There are not sufficient predictive tools for survival prognosis in those patients. ObjectiveTo verify the validity and application of a prognostic tool designed for a hospital, with analytical parameters for its application in the home setting. Materials and methodsProspective, observational and analytical study on patients with terminal cancer cared by a home care support team from 10/1/03 to 7/11/05. A blood sample was taken for the analysis of laboratory tests on those patients with, inclusion criteria and prior informed consent. Prognostic significance of the variables obtained for a survival equal to or less than 30 days was analysed. The predictive model to validate was represented by a logistic equation. Its predictive capacity was analysed by calculating the ROC and its corresponding AUC with a 95% confidence interval (CI). ResultsThe model and the prognostic equation of Nabal and col. were applied in 80 patients. This collect information associated with cachexia-anorexia syndrome and the organs involved. Only leukocytes and neutrophils showed a statistically significant difference for survival equal to or less than 30 days. ConclusionsThe sample size was small due to the difficulty of working in the home. The results do not agree with other models, questioning the validity of this tool in our environment. More studies that adjust the methodology developed in the field of home care are required.