Pain management effectiveness in advanced cancer: palliative care unit inpatient study.

OBJECTIVES: The aim of this study is to evaluate pain management adequacy based on the Pain Management Index (PMI), and its association with the Brief Pain Inventory (BPI) in advanced cancer inpatients to a palliative care unit. METHODS: This is a quantitative study concerning advanced cancer inpatients in a specialised palliative care unit between June 2021 and February 2022. The BPI was applied, and analgesia was observed on the first (D1), third (D3) and seventh (D7) day of hospitalisation. Adequate analgesia was considered when PMI≥0. RESULTS: A total of 104 patients were evaluated on D1, 68 on D3 and 45 on D7, with a mean age of 53.6 years (SD±14.1), most of them female (65.4%), with the most frequent primary tumour site located in the gastrointestinal tract (22.1%). The observed analgesia was adequate (PMI≥0) in 52.9% of all patients on D1, 95.6% on D3 and 100% on D7 (p value=0.012). The number of patients with moderate to severe pain interference in general activities (p value 0.012), mood (p value 0.014), walking ability (p value 0.047), normal work (p value 0.038) and pleasure of living (p value 0.025) decreased during hospitalisation. CONCLUSIONS: Pain is a prevalent and impacting symptom in patients undergoing palliative care. Thus, objective analgesic adequacy assessments in specialised services are required. These findings reinforce the importance of effective pain control and corroborate the importance of employing objective tools in evaluating medical services and improving quality of life of patients.

Prevalence and factors associated with the occurrence of pathological fractures and their impact on the overall survival of patients with bone metastases under palliative care.

OBJECTIVES: To assess the prevalence and factors associated with the occurrence of pathological fractures and their impact on the overall survival of patients with bone metastases under palliative care. METHODS: An observational retrospective cohort assessment concerning both male and female patients with cancer presenting with bone metastases referred to a palliative care unit. Sociodemographic and clinical data were obtained before and after care unit referral. Patients were followed up until death or the last follow-up (4 years after referral). Logistic regression models and survival curves employing a log-rank test were applied. RESULTS: A total of 348 patients were included in the study. Most were <65 years (65%) and female (62%), and the most frequent primary tumour site was the breast (40%). The prevalence of pathological fractures was 28%, more frequent in the axial skeleton (49%), with no association with overall patient survival (p=0.348). Patients with breast cancer exhibited a 2.96-fold higher chance (95% CI: 1.80 to 4.86) of developing a fracture compared with other tumours, and not receiving previous radiotherapy increased the chances of fracture occurrence by 5.60-fold (95% CI: 2.46 to 12.77). CONCLUSION: A high prevalence of pathological fractures was observed. Presenting with breast cancer and not having undergone previous radiotherapy increase the chances of fracture occurrence, although this is not associated with overall survival in patients under palliative care.

Correlation Between Cancer Pain and Quality of Life in Patients With Advanced Cancer Admitted to a Palliative Care Unit.

INTRODUCTION: Cancer pain is one of the most prevalent manageable symptoms in patients with advanced cancer, and it has a negative impact on quality of life (QoL). OBJECTIVE: The aim of this study is to examine the correlation between cancer pain and QoL in patients with advanced cancer who are hospitalized in a palliative care unit. METHODS: This study is a cross-sectional analysis of patients with advanced cancer who were hospitalized with cancer pain at a specialized palliative care unit between June 2021 and February 2022. Pain intensity and its impact on daily activities were assessed using the Brief Pain Inventory (BPI), while the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 15 PAL (QLQ-C15-PAL) was used to evaluate QoL. RESULTS: A total of 104 patients with cancer pain were included, with a mean age of 53.6 years (±14.1). Most of the patients were female (65.38%), and the most common primary tumor site was in the gastrointestinal tract (22.11%). The most frequently reported site of cancer pain was the abdomen (32.69%). The mean duration of cancer pain was 52.3 days (±6.2). The domains of QoL most strongly correlated with cancer pain were weakness (coefficient = .52, P < .001), nausea (coefficient = .36, P < .001), and the physical domain (coefficient = -.30, P < .001). CONCLUSION: Cancer pain is strongly correlated with a deterioration in QoL in patients with advanced cancer, and its management should be pursued as a strategy for optimizing QoL.

Factors Associated with Karnofsky Performance Status and its Trajectory in the Last Month of Life in Patients with Terminal Cancer / Fatores Associados ao Karnofsky Performance Status e sua Trajetória no Último Mês de Vida em Pacientes com Câncer Terminal / Factores Asociados al Karnofsky Performance Status y su Trayectoria en el Último Mes de Vida en Pacientes Oncológicos Terminales

Introduction: Karnofsky Performance Status (KPS) can characterize the impact of the disease on cancer patients. Objective: To evaluate the factors associated with KPS and its trajectory in the last month of life in patients with terminal cancer. Method: Retrospective cohort study, with terminal cancer patients enrolled in a Palliative Care Unit, who died between July and August 2019. The dependent variable was the KPS assessed daily in the last month of life. A cross-sectional analysis of factors associated with initial KPS was performed using ordinal logistic regressions. To verify the trajectory of KPS in the last month of life, longitudinal graphic analyzes were performed. Results: 108 patients were evaluated, most of whom were >60 years old (68.5%) and female (62.0%). The most prevalent tumor sites were the gastrointestinal tract (GIT) (24.3%), breast (18.7%) and head and neck (HN) (16.8%). In the multiple model, the primary tumor sites remained associated with KPS. During the last month of life, the reduction in KPS was more pronounced in those with tumors in the GIT, HN and connective bone tissue, who had higher KPS values on the thirtieth day before death when compared to the others. On the other hand, those with central nervous system and lung cancer started the follow-up period with lower KPS values and had a less exacerbated reduction than the others. Conclusion: KPS values decrease in the last month of life, but with different intensity according to the tumor site in patients with terminal cancer

Introdução: O Karnofsky Performance Status (KPS) pode caracterizar o impacto da doença em pacientes com câncer. Objetivo: Avaliar os fatores associados ao KPS e a sua trajetória no último mês de vida em pacientes com câncer terminal. Método: Estudo de coorte retrospectivo, com pacientes com câncer terminal internados em uma unidade de cuidados paliativos, falecidos entre julho e agosto de 2019. A variável dependente foi o KPS avaliado diariamente no último mês de vida. Uma análise transversal dos fatores associados ao KPS inicial foi realizada por meio de regressões logísticas ordinais. Para verificar a trajetória do KPS no último mês de vida, foram realizadas análises gráficas longitudinais. Resultados: Foram avaliados 108 pacientes, cuja maioria possuía >60 anos (68,5%) e era do sexo feminino (62,0%). Os sítios tumorais mais prevalentes foram o trato gastrointestinal (TGI) (24,3%), mama (18,7%) e cabeça e pescoço (CP) (16,8%). No modelo múltiplo, os sítios tumorais primários permaneceram associados ao KPS. Durante o último mês de vida, a redução do KPS foi mais pronunciada naqueles com tumor no TGI, CP e tecido ósseo conjuntivo, que apresentaram valores mais elevados de KPS no trigésimo dia antes do óbito quando comparados aos demais. Por outro lado, aqueles com câncer no sistema nervoso central e pulmão iniciaram o período de seguimento com valores de KPS mais baixos e tiveram redução menos exacerbada que os demais. Conclusão: Os valores de KPS diminuem no último mês de vida, porém com intensidade diferente de acordo com o local do tumor em pacientes com câncer terminal.

Introducción: Karnofsky Performance Status (KPS) puede caracterizar el impacto de la enfermedad en pacientes con cáncer. Objetivo: Evaluar los factores asociados al KPS y su trayectoria en el último mes de vida en pacientes con cáncer terminal. Método: Estudio de cohortes retrospectivo, con pacientes oncológicos terminales ingresados en una Unidad de Cuidados Paliativos, fallecidos entre julio y agosto de 2019. La variable dependiente fue el KPS valorado diariamente en el último mes de vida. Se realizó un análisis transversal de los factores asociados con KPS inicial mediante regresiones logísticas ordinales. Para verificar la trayectoria de KPS en el último mes de vida, se realizaron análisis gráficos longitudinales. Resultados: Se evaluaron 108 pacientes, la mayoría con >60 años (68,5%) y del sexo femenino (62,0%). Los sitios tumorales más prevalentes fueron el tracto gastrointestinal (TGI) (24,3%), mama (18,7%) y cabeza y cuello (CC) (16,8%). En el modelo múltiple, los sitios del tumor primario permanecieron asociados con KPS. Durante el último mes de vida, la reducción de KPS fue más pronunciada en aquellos con tumores en TGI, CC y tejido conectivo óseo, quienes tenían valores de KPS más altos en el trigésimo día antes de la muerte en comparación con los demás. Por otro lado, aquellos con cáncer de sistema nervioso central y pulmón comenzaron el período de seguimiento con valores más bajos de KPS y tuvieron una reducción menos exacerbada que los demás. Conclusión: Los valores de KPS disminuyen en el último mes de vida, pero con distinta intensidad según la localización del tumor en pacientes con cáncer terminal.