Under the national plan for addressing cancer, prevention and detection play important roles. However, the cost of treatments and late diagnosis represent a significant burden on health services. At the National Cancer Institute, more than half of patients present with tumors in advanced stages, and approximately 10% of patients seen for the first time exhibit terminal-stage malignancies, where there are no feasible cancer treatment options, and the patients are instead admitted to the hospital exclusively for palliative symptomatic management. In 2010, the National Cancer Plan began implementing a model of integrative management of palliative care in oncology that has gradually come to include symptomatic palliative care, involving ambulatory, distant and hospitalized management of patients with cancer, in its final stages and, more recently, in earlier stages. ResumenEn el marco del plan nacional para abordar el cáncer, la prevención y la detección juegan un papel importante. Sin embargo, el costo de tratamientos y diagnóstico tardío representan una carga significativa en los servicios de salud. En el Instituto Nacional del Cáncer, más de la mitad de los pacientes presentan tumores en etapas avanzadas, y aproximadamente10% de los pacientes que acuden a consulta por primera vez presentan malignidades en etapa terminal, donde no hay opciones factibles para de tratamiento del cáncer; en su lugar, los pacientes son admitidos en el hospital exclusivamente para manejo sintomático paliativo. En 2010, el Plan Nacional del Cáncer comenzó a implementar un modelo de gestión integral de los cuidados paliativos en oncología que ha logrado gradualmente incluir cuidados sintomáticos paliativos, incluyendo manejo ambulatorio, distante y hospitalizado de los pacientes con cáncer en fase final y, más recientemente, en las primeras fases.Palabras clave: oncología integrada; cuidados paliativos; cuidado del cáncer terminal http://dx.doi.org/10.21149/spm.v58i2.7803

ObjectiveAccurate forecasting the life expectancy of patients with cancer is adamantly needed for adequate decision-making in the Palliative Care Services (PCS) context. Nonetheless, physician forecast is often inaccurate, hindering end of life (EOL) decisions. In this study, we determined the prognostic value of two oncology performance status (PS) scales at first referral to PCS.MethodsRetrospective analysis of 6310 patients consecutively admitted to PCS at the Instituto Nacional de Cancerología (2012–2018). Demographic and PS (as per Karnofsky (KPS) and Eastern Cooperative Oncology Group (ECOG) scales) information was retrieved and the overall survival of patients calculated according to PS. Concordance of each scale was assessed in the overall population and according to age.ResultsOverall survival was significantly associated with ECOG and KPS (p<0.05). A total of 2278 (36.1%) and 2296 (36.4%) patients were referred to PCS in their last month of life and most had a poor PS (ECOG 3–4, 59.1%; KPS <50, 54.4%). Both PS scales had high concordance in the overall population (K=0.6189 (KPS); K=0.6058 (ECOG)), but a higher value was observed among the subgroup of patients aged ≥65 (K=0.6339 (KPS); 0.6252 (ECOG)). Concordance was lowest among younger (≤39) patients.ConclusionsPS as assessed by the most widely known tools is strongly associated with overall survival of patients with cancer attending PCS. No large differences were observed among the scales, though results slightly favour the use of KPS. Early referral to PCS and accurate survival prediction can aid in relevant decision-making for patients approaching EOL.

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Background: Cancer is a major burden of disease and a public health problem, as it is one of the main causes of morbidity and mortality worldwide. It is estimated that 25% of cancer patients die without receiving proper pain management. Objective: To acknowledge the epidemiological profile of first-time patients at the palliative care service of a referral center, along with the pharmaceutical treatment and social and familiar implications of the treatment costs in first-time patients. Methods: A survey including 28 questions was conducted including 490 first-time patients at the National Cancer Institute in Mexico City. Results: Median age was 53 years; 63.3% (n = 310) were females; 72% were married or single (50.5% and 21.2%, respectively). The most frequent diagnoses were gastrointestinal tumors, followed by urological, and skin/soft tissue carcinomas (19.8%, 12.5%, and 12%, respectively). Pain prevalence was 50.4% among the cohort. From the subgroup of participants with pain, 26.7% presented an intensity ≥7. Conclusions: As most patients in our study presented pain, there is a need of strengthening public policy about opioid treatments.