Proposal of a nutrition screening algorithm for patients with incurable cancer receiving palliative care: Data from a prospective cohort.

OBJECTIVE: To propose and evaluate the clinical utility of a new nutrition screening algorithm, NutriPal, to detect the degree of nutritional risk in patients with incurable cancer receiving palliative care. METHODS: It is a prospective cohort conducted in an oncology palliative care unit. The NutriPal algorithm was used in a three-step process: (i) administration of the Patient-Generated Subjective Global Assessment short form; (ii) calculation of the Glasgow Prognostic Score; and (iii) application of the algorithm to classify patients into four degrees of nutritional risk. The higher the degrees of NutriPal, the worse the nutritional risk, comparing nutritional measures, laboratory data, and overall survival (OS). RESULTS: The study included 451 patients that were classified using the NutriPal. They were allocated to the degrees: 1 (31.26%), 2 (27.49%), 3 (21.73%), and 4 (19.71%). Statistically significant differences were found in most of the nutritional and laboratory parameters and in OS with each increment in the NutriPal degrees, and OS was reduced (log-rank <0.001). In addition, NutriPal was able to predict a 120-day mortality: there was a significantly higher risk of death in the patients classified as degrees 4 (hazard ratio [HR], 3.03; 95% confidence interval [95% CI], 2.18-4.19), 3 (HR, 2.01; 95% CI, 1.46-2.78), and 2 (HR, 1.42; 95% CI; 1.04-1.95) than in those classified as degree 1. It also showed good predictive accuracy (concordance statistic, 0.76). CONCLUSION: The NutriPal is associated to nutritional and laboratory parameters and can predict survival. It could therefore be incorporated into clinical practice for patients with incurable cancer receiving palliative care.

Quality of death educational programme in a national reference palliative care unit.

OBJECTIVE: To report the experience of offering the Quality End of Life Care for All (QELCA) Programme, highlighting the distinct methodology for the training of health professionals. DEVELOPMENT: The QELCA Programme, intellectual property of St Christopher's Hospice, was offered to seven health professionals working in the hospital palliative care unit at the National Cancer Institute, between June and December 2022, with the support of Premier Institute. The programme, which originates in the UK, has been evaluated there and is currently being evaluated in Hong Kong, and is delivered in two phases: (1) a 5-day immersion programme; (2) monthly sessions of Action Learning for 6 months. Participants realised that communication between members of the multidisciplinary team, as well as between health professionals and patients/loved ones, was one of the key challenges for achieving quality of death in the hospital palliative care unit. This insight empowered them to drive forward significant changes in practice that promise to improve quality of care. CONCLUSION: The QELCA Programme enabled participants to engage in active problem-solving to promote the relief of suffering of patients and their families in end-of-life care.

Clinical usefulness of the Patient-Generated Subjective Global Assessment and modified Glasgow Prognostic Score in decision making concerning the indication of enteral nutritional therapy in patients with incurable cancer receiving palliative care.

OBJECTIVES: This study aimed to identify the clinical usefulness of assessing nutritional status using validated tools for the indication of enteral nutrition for patients with incurable cancer in palliative care. METHODS: In this prospective cohort study, patients were assessed for nutritional risk using the Patient-Generated Subjective Global Assessment and for cancer cachexia (CC) using the modified Glasgow Prognostic Score upon enrollment and after ∼30 d. The outcome was stable or improved Karnofsky Performance Status. Logistic regression models were used, providing the odds ratio (OR) and 95% confidence interval (CI). RESULTS: A total of 180 patients participated. The only nutritional status parameter that was associated with function was CC. The less severe the CC, the more likely Karnofsky Performance Status was to remain stable or improve over 30 d (non-cachectic: OR = 1.95; 95% CI, 1.01-3.47; malnourished: OR = 1.06; 95% CI, 1.01-1.42). Furthermore, white skin color (OR = 1.79; 95% CI, 1.04-2.47), higher educational level (OR = 1.39; 95% CI, 1.13-2.78), and inadequate calorie intake (OR = 1.96; 95% CI, 1.02-2.81) were also associated with the outcome. CONCLUSIONS: Using the modified Glasgow Prognostic Score to identify the existence and severity of CC, which is associated with function, has the potential to help clinical decision making concerning the indication of enteral nutrition in patients with incurable cancer receiving palliative care.

Cancer patients with COVID-19: does prior nutritional risk associated with cancer indicate a poor prognosis for COVID-19?

OBJECTIVE: To verify whether the presence of related nutritional risk indicators prior to COVID-19 diagnosis is associated with poor survival in patients with cancer. METHODS: We retrospectively analyzed the data of hospitalized cancer patients who tested positive for COVID-19 between March 2020 and February 2021. Nutritional risk was defined as the presence of one of the following characteristics: body mass index <20kg/m 2 , scored Patient-generated Subjective Global Assessment ≥9 points or classification B, albumin level <3.5g/dL, and C-reactive protein level ≥10mg/L, evaluated between 7 and 60 days prior to the date of patient inclusion. The endpoint measure was all-cause mortality within 30 days of COVID-19 diagnosis. RESULTS: A total of 253 patients were included, most of whom were elderly (62.4%) and female (63.6%). Overall, 45.4% of the patients were at nutritional risk. Survival was significantly lower in patients at nutritional risk (8 days; interquartile range [IQR]: 3-29) than in patients not at nutritional risk (16 days; IQR: 6-30) (p<0.001). The presence of prior nutritional risk was associated with increased 30-day mortality (HR: 1.42; 95%CI: 1.03-1.94), regardless of age, gender, tumor site or stage, and other risk factors, and the model had good discrimination accuracy (concordance statistic: 0.744). CONCLUSION: The presence of prior nutritional risk indicators is related to poor prognosis in patients with cancer and COVID-19, emphasizing the importance of nutritional care, notably during this pandemic.

Cancer patients with COVID-19: does prior nutritional risk associated with cancer indicate a poor prognosis for COVID-19?

ABSTRACT Objective To verify whether the presence of related nutritional risk indicators prior to COVID-19 diagnosis is associated with poor survival in patients with cancer. Methods We retrospectively analyzed the data of hospitalized cancer patients who tested positive for COVID-19 between March 2020 and February 2021. Nutritional risk was defined as the presence of one of the following characteristics: body mass index <20kg/m 2 , scored Patient-generated Subjective Global Assessment ≥9 points or classification B, albumin level <3.5g/dL, and C-reactive protein level ≥10mg/L, evaluated between 7 and 60 days prior to the date of patient inclusion. The endpoint measure was all-cause mortality within 30 days of COVID-19 diagnosis. Results A total of 253 patients were included, most of whom were elderly (62.4%) and female (63.6%). Overall, 45.4% of the patients were at nutritional risk. Survival was significantly lower in patients at nutritional risk (8 days; interquartile range [IQR]: 3-29) than in patients not at nutritional risk (16 days; IQR: 6-30) (p<0.001). The presence of prior nutritional risk was associated with increased 30-day mortality (HR: 1.42; 95%CI: 1.03-1.94), regardless of age, gender, tumor site or stage, and other risk factors, and the model had good discrimination accuracy (concordance statistic: 0.744). Conclusion The presence of prior nutritional risk indicators is related to poor prognosis in patients with cancer and COVID-19, emphasizing the importance of nutritional care, notably during this pandemic.

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.

Temporal trends and factors associated with the cancer diagnosed at stage IV in patients included in the integrated hospital-based cancer registry system in Brazil in two decades.

BACKGROUND: In several countries, such as Brazil, the oncological diagnosis usually occurs at an advanced stage of the disease. Thus, the aim of this study was to investigate temporal trends and factors associated with the cancer diagnosed at stage IV in Brazil in two decades. METHODS: Secondary-based study, with time series analysis for trend assessment and cross-sectional of factors associated with diagnosis of female breast, prostate, cervix uteri, colorectal, lung, stomach, lip and oral cavity, thyroid, esophagus or corpus uteri at stage IV. RESULTS: 1,218,322 cases were evaluated. The types of cancer with the highest proportion of stage IV at diagnosis in men and women, respectively, were: lung (53.7% and 57.4%), stomach (48.4% and 45.0%) and lip/oral cavity (53.5% and 43.4%). Most showed an increasing trend of annual percent change of cancer diagnosed at stage IV, being more pronounced in corpus uteri cancer (2013-2019: +7.4%, p < 0.001). The odds of cancer diagnosed at stage IV were associated with different factors, according to primary tumor site, but marked by the inverse association with female sex [odds ratio (OR) ranging from 0.42 to 0.91, p < 0.001] and direct association in cases with < 7 years of study (OR ranging from 1.08 to 1.81, p < 0.001), living without a partner (OR ranging from 1.06, p < 0.050 to1.27, p < 0.001), living in the South and Southeast regions (OR ranging from 1.04 to 1.13, p < 0.001), with more than one tumor (OR ranging from 1.19, p < 0.050 to 1.54, p < 0.001) and treated in Centers of High Complexity in Oncology (OR ranging from 1.03, p < 0.050 to1.24, p < 0.001). CONCLUSION: There was a high frequency of cancer diagnosed at stage IV and an increasing trend in different cancer types, which were associated with distinct sociodemographic, lifestyle, and clinical factors.

Clinical Relevance and Prognostic Value of Inflammatory Biomarkers: A prospective Study in Terminal Cancer Patients Receiving Palliative Care.

CONTEXT: Inflammatory biomarkers have prognostic value in cancer patients, but the feasibility of their use with terminal cancer patients and the related cutoff points are poorly explored. OBJECTIVES: To describe the percentiles values of inflammatory biomarkers; to identify their cutoff points in relation to death; and to determine the prognostic value of C-reactive protein (CRP), leukocytes, neutrophils, neutrophil/lymphocyte ratio (NLR), CRP/albumin ratio (CAR), and modified Glasgow Prognostic Score for death within 90 days, in terminal cancer patients receiving palliative care. METHODS: Prospective cohort study that included patients who received palliative care at the Palliative Care Unit of the National Cancer Institute (Brazil) between October 2019 and March 2020. Receiver operating characteristic curves were used to identify the optimal cutoff points of the inflammatory biomarkers for the prediction of death in 90 days. Kaplan-Meier curves and Cox regression were used to verify the prognostic value of these cutoff points and concordance statistic (C-statistic) was used to test their predictive accuracy. RESULTS: A total 205 patients (mean age: 62.5 years; female: 59%) were included in the study. The optimal cutoff points were CRP ≥6.7mg/L, CAR ≥2.0, leukocytes ≥9300/µL, neutrophils ≥7426/µL and NLR ≥6.0. All biomarkers showed prognostic value and good predictive accuracy when their cutoff points were used, especially CAR, which presented excellent discrimination power (C-statistic: 0.80). CONCLUSION: The inflammatory biomarkers analyzed are independent predictive factors for death within 90 days in terminal cancer patients. CAR appears to be the most useful parameter for predicting survival in these patients.

Palliative Care and COVID-19 Pandemic: Retrospective Study of Factors Associated With Infection and Death at an Oncological Palliative Care Reference Center.

BACKGROUND: Advanced cancer patients are part of a group likely to be more susceptible to COVID-19. AIMS: To describe the profile of advanced cancer inpatients to an exclusive Palliative Care Unit (PCU) with the diagnosis of COVID-19, and to evaluate the factors associated with death in these cases. DESIGN: Retrospective cohort study with data from advanced cancer inpatients to an exclusive PCU, from March to July 2020, with severe acute respiratory syndrome. Diagnostic of COVID-19 and death were the dependent variables. Logistic regression analyses were performed, with the odds ratio (OR) and 95% confidence interval (CI). RESULTS: One hundred fifty-five patients were selected. The mean age was 60.9 (±13.4) years old and the most prevalent tumor type was breast (30.3%). Eighty-three (53.5%) patients had a diagnostic confirmation of COVID-19. Having diabetes mellitus (OR: 2.2; 95% CI: 1.1-6.6) and having received chemotherapy in less than 30 days before admission (OR: 3.8; 95% CI: 1.2-12.2) were associated factors to diagnosis of COVID-19. Among those infected, 81.9% died and, patients with Karnofsky Performance Status (KPS) < 30% (OR: 14.8; 95% CI 2.7-21.6) and C-reactive protein (CRP) >21.6mg/L (OR: 9.3; 95% CI 1.1-27.8), had a greater chance of achieving this outcome. CONCLUSION: Advanced cancer patients who underwent chemotherapy in less than 30 days before admission and who had diabetes mellitus were more likely to develop Coronavirus 2019 disease. Among the confirmed cases, those hospitalized with worse KPS and bigger CRP were more likely to die.

Predictive Factors of Death on Hospitalization in Patients With Advanced Cancer in Palliative Care.

BACKGROUND: Prognostic assessment is essential to plan the care of patients with advanced cancer in palliative care. OBJECTIVE: Thus, this study aims to assess the predictors of death in inpatients with advanced cancer in palliative care. METHODS: This is a clinical, observational cohort study with patients aged >20 years, of both genders, evaluated within 48 hours of the first hospitalization. The independent variables were tumor location, nutritional risk [through the Patient-Generated Subjective Global Assessment (PG-SGA) short form], laboratory tests [C-reactive protein and albumin] and Karnofsky Performance Status (KPS). Logistic regression analyses were performed. RESULTS: Eighty-two patients were evaluated, whose mean age was 61.8 (± 13.2) years. Forty-nine (59.8%) patients died during hospitalization, among which the majority had KPS of 30-40% (p-value = 0.043), higher means of the total score of the PG-SGA (p-value = 0.050) and lower serum albumin concentrations (p-value = 0.011). According to the multivariate model, tumor location in the gastrointestinal (GI) tract (OR: 1.73; 95% CI: 1.57-1.94), 30-40% KPS (OR: 1.29; 95% CI: 1.07-1.63) and albumin concentrations <3.5 g/dL (OR: 4.65; 95% CI: 1.22-17.7) were independent factors associated with an increased chance of death from hospitalization. CONCLUSION: Presenting an advanced tumor with localization in the GI tract, KPS ≤40% and serum albumin concentration <3.5 g/dL at admission were predictors of death in inpatients under palliative care.

The Nutritional Approach Challenge of a Patient with Colon Cancer and Leptomeningeal Metastasis in Clinical Practice: Case Report / Desafio da Abordagem Nutricional de uma Paciente com Câncer de Cólon e Metástase Leptomeníngea na Prática Clínica: Relato de Caso / El Reto de la Abordaje Nutricional de una Paciente con Cáncer de Colon y Metástasis Leptomeníngeas em la Práctica Clínica: Relato de Caso

Introduction: Leptomeningeal metastasis is an extremely rare evolution of colon cancer, with reduced survival, requiring early palliative treatment in order to improve the patient's quality of life. The aim of this study was to report the case of a patient with colon cancer with leptomeningeal carcinomatosis, from the perspective of the nutritional approach in exclusive palliative care. Case report: Young female patient with diagnosis of colon cancer, metastatic to leptomeninges, admitted to a Palliative Care Unit, with reduced functionality and nutritional risk. From the 1st to the 8th day of hospitalization, she remained on zero diet. In the few moments when she was more alert, there was an attempt to offer liquid oral diet, which could not be achieved due to high risk of bronchoaspiration. After multiprofessional team discussions and conversations with the patient's family members, it was decided to place the nasoenteric catheter (NEC). The patient alternated periods on zero diet and nutrition by NEC according to clinical and nutritional conditions. Conclusion: It is necessary to reconcile a safe food route for quality of life and death, considering not only the patient, but the feelings and meanings the family members attribute to food

Introdução: A metástase leptomeníngea é uma evolução extremamente rara do câncer de cólon, com sobrevida reduzida, demandando tratamento paliativo precoce no intuito de melhorar a qualidade de vida do paciente. O objetivo deste estudo foi relatar o caso de uma paciente com câncer de cólon com carcinomatose leptomeníngea, sob a perspectiva da abordagem nutricional em cuidados paliativos exclusivos. Relato do caso: Paciente jovem, sexo feminino, com diagnóstico de câncer de cólon, metastático para leptomeninge de rara evolução, admitida na Unidade de Cuidados Paliativos, com funcionalidade reduzida e risco nutricional. Do 1º ao 8º dia de internação, manteve dieta zero. Nos poucos momentos em que esteve mais alerta, houve uma tentativa de oferta de dieta via oral líquida, o que não pôde ser alcançado em virtude do alto risco de broncoaspiração. Após discussões entre a equipe multiprofissional e conversas com familiares da paciente, optou-se pela colocação do cateter nasoentérico (CNE). A paciente alternava períodos de dieta zero e nutrição pela CNE de acordo com suas condições clínicas e nutricionais. Conclusão: É necessário conciliar uma via alimentar segura para qualidade de vida e de morte, contemplando não somente o paciente, como também os sentidos e significados atribuídos à alimentação por seus familiares

Introducción: La metástasis leptomeníngea es una evolución extremadamente rara del cáncer de colon, con supervivencia reducida, requiriendo tratamiento paliativo precoz para mejorar la calidad de vida del paciente. El objetivo de este estudio fue reportar el caso de una paciente con cáncer de colon con carcinometosis leptomeníngea, desde la perspectiva del abordaje nutricional en cuidados paliativos exclusivos. Relato del caso: Paciente joven con diagnóstico de cáncer de colon, metastásico a leptomeninge, ingresado en una Unidad de Cuidados Paliativos, con funcionalidad y riesgo nutricional reducidos. Desde el 1º al 8º día de hospitalización, permaneció con dieta cero. En los pocos momentos en que estuvo alerta, se intentó ofrecer dieta líquida oral, lo que no se pudo lograr por alto riesgo de broncoaspiración. Luego de discusiones entre el equipo multiprofesional y conversaciones con familiares del paciente, se decidió colocar el catéter nasoentérico (CNE). El paciente alternó períodos de dieta cero y nutrición por CNE de acuerdo con sus condiciones clínicas y nutricionales. Conclusión: Es necesario conciliar una ruta alimentaria segura para la calidad de vida y la muerte, contemplando no solo al paciente, sino también los sentidos y significados atribuidos a la alimentación por sus familiares

Prognostic assessment in palliative cancer care: is there a difference between adult and older patients? / Avaliação prognóstica em cuidados paliativos oncológicos: Há diferença entre pacientes adultos e idosos?

OBJECTIVE: To compare factors associated with death in adults and older people with advanced cancer who were hospitalized in a palliative care unit (PCU). METHODS: Case-control study with patients (adults vs older people) admitted to a PCU of National Cancer Institute José Alencar Gomes da Silva (INCA), in Rio de Janeiro, Brazil. Logistic regressions (odds ratio [OR] and 95% confidence interval [95%CI]) were used to identify factors associated with death. RESULTS: The study included 205 patients, most of which were aged over 60 years old (60.5%). Among the adult patients, a Karnofsky Performance Status ≤ 40% (OR 2.54 [95%CI 1.11­3.45]) and neutrophil-to-lymphocyte ratio (NLR) (OR 1.09 [95%CI 1.02­1.24]) were risk factors for death, while albumin (OR 0.30 [95%CI 0.12­0.78]) was a protective factor. Among older patients, NLR (OR: 1.13 [95%CI 1.02­1.24]), C-reactive protein (CRP) (OR 1.09 [95%CI 1.02­1.17]), modified Glasgow Prognostic Score (mGPS) 1 and 2 (OR 4.66 [95%CI 1.35­16.06]), CRP-to-albumin ratio (CAR) (OR 1.27 [95%CI 1.03­1.58]), and nutritional risk (OR 1.11 [95%CI 1.03­1.19]) were risk factors, whereas albumin (OR 0.23 [95%CI 0.09­0.57]) was a protective factor against death. CONCLUSIONS: Prognostic factors differed between groups. The NLR was a risk factor, and albumin was a protective factor regarding death in both groups. Additionally, CRP, mGPS, CAR, and nutritional risk were associated with an increased risk of death only among older people.

OBJETIVO: Comparar os fatores associados ao óbito entre adultos e idosos com câncer avançado internados em uma Unidade de Cuidados Paliativos (UCP). METODOLOGIA: Estudo de caso-controle com pacientes (adultos versus idosos) internados em uma UCP do Instituto Nacional do Câncer José Alencar Gomes da Silva (INCA), no Rio de Janeiro, Brasil. Regressões logísticas (Odds Ratio [OR] e intervalo de confiança de 95% [IC95%]) foram utilizadas para identificar os fatores associados ao óbito. RESULTADOS: Participaram 205 pacientes, com predomínio de idosos (60,5%). Entre os adultos, o Karnofsky Performance Status ≤ 40% (OR 2,54 [IC95% 1,11 ­ 3,45]) e a razão neutrófilo-linfócito (RNL) (OR 1,09 [IC95% 1,02 ­ 1,24]) foram fatores de risco, e a albumina (OR 0,30 [IC95% 0,12 ­ 0,78]) foi fator de proteção para o óbito. Nos idosos, a RNL (OR 1,13 [IC95% 1,02 ­ 1,24]), a proteína C-reativa (PCR) (OR 1,09 [IC95% 1,02 ­ 1,17]), o escore prognóstico de Glasgow modificado (EPGm) 1 e 2 (OR 4,66 [IC95% 1,35 ­ 16,06]), a razão PCR-albumina (RPA) (OR 1,27 [IC95% 1,03 ­ 1,58]) e o risco nutricional (OR 1,11 [IC95% 1,03 ­ 1,19]) foram fatores de risco, e a albumina (OR 0,23 [IC95% 0,09 ­ 0,57]) foi fator de proteção para o óbito. CONCLUSÕES: Os fatores prognósticos diferiram entre os grupos. A funcionalidade e a RNL foram fatores de risco e a albumina foi fator de proteção para o óbito em ambos os grupos. Adicionalmente, somente nos idosos, a PCR, o EPGm, a RPA e o risco nutricional foram associados ao aumento do risco de mortalidade.

Advanced Stage of Disease and Systemic Inflammation as Factors Associated With Referral of Patients With Colorectal Cancer to a Palliative Care Unit.

OBJECTIVE: To identify factors associated with referral to an exclusive palliative care unit (PCU) in patients with colorectal cancer (CRC). METHODS: Retrospective cohort study with patients having CRC of both sexes treated at a hospital unit, aged ≥20 years. Data were extracted from the medical records of pretreatment patients between January 2008 and August 2014. The outcome was referral to the PCU within 5 years. Logistic regression analyses were performed to assess whether sociodemographic, clinical, nutritional, and biochemistry data were associated to referral, generating odds ratios (OR), and 95% confidence intervals (CI). RESULTS: Four hundred fifteen patients were evaluated. The Patient-Generated Subjective Global Assessment demonstrated a prevalence of malnutrition of 57.3%. One hundred one (24.3%) patients were referred to the PCU after 16.3 months (interquartile range: 7.2-33.5). These patients were more likely to be at an advanced stage of the disease and have malnutrition and exacerbated systemic inflammation. Tumor stage III and IV (OR: 2.05; 95% CI: 1.12-3.76) and neutrophil-to-lymphocyte ratio (NLR) ≥3 (OR: 1.89; 95% CI: 1.12-3.17) were predictors of an increased chance of referral to the PCU. CONCLUSION: Advanced disease stage and NLR were associated with referral of patients with CCR to a PCU.