Portugal has a high prevalence of therapeutic aggressiveness at the end of life for cancer patients – 7 out of 10 who died in a public hospital in mainland Portugal between 2010 and 2015 received care considered to be aggressive – according to a study published in ESMO Open of the European Society of Medical Oncology.
The study, led by King’s College London, involves researchers and clinicians from the Portuguese Institutes of Oncology in Lisbon, Coimbra and Porto, the Escola Nacional de Saúde Pública, the Instituto de Saúde Pública da Universidade do Porto (ISPUP) and the Faculdade de Medicina da Universidade de Coimbra. The article alerts to one of the highest prevalences of therapeutic aggressiveness at the end of life for cancer patients in Portugal, when compared to other western countries.
The research team conducted a retrospective analysis including all adult cancer patients who died in public hospitals in mainland Portugal between January 2010 and December 2015 (6 years). The aggressiveness of end-of-life care was assessed through the presence of at least 1 of 16 individual indicators during the last 30 days of life. These indicators include factors related to hospital admission, cancer treatments and invasive procedures.
The study included more than 92 thousand patients and identified a prevalence of 71% of exposure to care considered to be aggressive at the end of life, a prevalence that remained stable during the 6 years studied. The most common individual indicators in the last 30 days of life were hospital stay for more than 14 days (43%) and surgery (28%).
The main author of the study, Diogo Martins Branco, says: “Despite oncological disease presenting one of the most predictable disease trajectories, the prognostic definition can be difficult in certain situations, resulting in aggressive care that compromises the quality of the end of life period. Therefore, the recognition of the most affected patients is the first step towards improving care in this context”.
The study identified the presence of comorbidities, gastrointestinal or hematological cancers and death in an oncology center or hospital with medical oncology as factors related to a greater exposure to aggressive care at the end of life.
The medical oncologist at the Portuguese Institute of Oncology in Lisbon and with a Masters in Palliative Care from King’s College London says that “oncologists should seek a better determination of prognostic estimates to provide adequate opportunities for an early discussion of preferences and expectations of patients and families, especially among patients from the higher risk groups identified in our study”.
The study did not find a decrease in the aggressiveness of end-of-life care for cancer patients with the existence of palliative care teams in the hospital where the death occurred. “This result may be due to the fact that hospitals with palliative care teams are often those with more complex patients. It can also be influenced by the fact that we measured the effect at the hospital level, since it was not possible for us to assess this at the patient level, we cannot say whether or not individual patients received this support. Additionally, late referral and the scarcity of resources of these teams, which we know are a reality in Portugal, may also explain these findings”, says Bárbara Gomes, principal investigator of the study and professor at the Faculdade de Medicina da Universidade de Coimbra who, since 2011, has developed research in order to optimize palliative care in Portugal, supported by the Calouste Gulbenkian Foundation.
She adds: “This study identifies a reality that we must reflect on, that we must continue to examine in future research and whose impact we do not know in the current context of the COVID-19 pandemic. We hope that the data will help to improve and personalize care for cancer patients”.
Image: IPOLFGCommunication Office
