Evaluación sintomática del paciente oncológico en urgencias
ABSTRACT Objetivos: Describir el perfil del paciente oncológico atendido en el servicio de urgencias de un hospital terciario, los motivos de consulta y su manejo clínico. Método: Desde octubre de 2007 a marzo de 2008, se recogieron las características de estos pacientes junto con los motivos de consulta y el manejo clínico de los pacientes oncológicos en el servicio de urgencias. Resultados: Se atendieron un total de 251 pacientes (12 pacientes/semana): 65 pacientes padecían cáncer de pulmón (25,9%), 47 padecían cáncer colorrectal (18,7%), y 32 cáncer de mama (12,7%). De todos ellos, 185 tenían enfermedad metastásica (73,7%) y 133 recibían tratamiento quimioterápico (52,9%). Los motivos de consulta más frecuentes fueron fiebre en 46 casos (18,3%), dolor relacionado con el tumor en 39 casos (15,5%), disnea en 36 casos (14,3%) y náuseas-vómitos en 28 casos (11,2%). Tras la atención urgente, 121 pacientes precisaron ingreso hospitalario (48,2%). Conclusiones: Los pacientes metastáticos y aquellos que están en tratamiento activo son los pacientes oncológicos que más demandan atención urgente y casi la mitad precisan ingreso hospitalario.
Full-textDOI: · Available from: Ana Isabel Ferrer Pérez, May 30, 2015
SourceAvailable from: Sally C. Morton
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ABSTRACT: The suffering of patients with incurable cancer is determined to a large degree by the presence and intensity of the symptoms of their disease. Knowledge of symptom prevalence is important for clinical practice. The main aim of this study was to obtain a reliable estimation of symptom prevalence in patients with incurable cancer by performing a systematic review of studies assessing this topic. We included 44 studies (including 25,074 patients) on overall symptom prevalence (Group 1) and six studies (including 2,219 patients) on symptom prevalence during the last one to two weeks of life (Group 2). In these studies, symptom prevalence was assessed by a questionnaire, a standardized interview, or the medical record. We identified 37 symptoms assessed in at least five studies. Almost all symptoms occurred in more than 10% of the patients. Five symptoms (fatigue, pain, lack of energy, weakness, and appetite loss) occurred in more than 50% of the patients of Group 1. Weight loss occurred significantly more often in Group 2 compared to Group 1, and pain, nausea, and urinary symptoms occurred significantly less often. Generally, symptom prevalence was highest if assessed by a questionnaire. The results of this study should be used to guide doctors and nurses in symptom management. Proper attention to symptom burden and suffering should be the basis for individually tailored treatment aimed at improving or maintaining quality of life of patients in their last period of life.Journal of Pain and Symptom Management 08/2007; 34(1):94-104. DOI:10.1016/j.jpainsymman.2006.10.015 · 2.74 Impact Factor
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ABSTRACT: Current end-of-life hospital care can be of poor quality and high cost. High volume and/or specialist care, and standardized care with clinical practice guidelines, has improved outcomes and costs in other areas of cancer care. The objective of this study was to measure the impact of the palliative care unit (PCU) on the cost of care. The PCU is a dedicated 11-bed inpatient (PCU) staffed by a high-volume specialist team using standardized care. We compared daily charges and costs of the days prior to PCU transfer to the stay in the PCU, for patients who died in the first 6 months after the PCU opened May 2000. We performed a case-control study by matching 38 PCU patients by diagnosis and age to contemporary patients who died outside the PCU cared for by other medical or surgical teams, to adjust for potential differences in the patients or goals of care. The unit admitted 237 patients from May to December 2000. Fifty-two percent had cancer followed by vascular events, immunodeficiency, or organ failure. For the 123 patients with both non-PCU and PCU days, daily charges and costs were reduced by 66% overall and 74% in "other" (medications, diagnostics, etc.) after transfer to the PCU (p < 0.0001 for all). Comparing the 38 contemporary control patients who died outside the PCU to similar patients who died in the PCU, daily charges were 59% lower (US dollars 5304 +/- 5850 to US dollars 2172 +/- 2250, p = 0.005), direct costs 56% lower (US dollars 1441 +/- 1438 to US dollars 632 +/- 690, p = 0.004), and total costs 57% lower (US dollars 2538 +/- 2918 to US dollars 1095 +/- 1153, p = 0.009). Appropriate standardized care of medically complex terminally ill patients in a high-volume, specialized unit may significantly lower cost. These results should be confirmed in a randomized study but such studies are difficult to perform.Journal of Palliative Medicine 11/2003; 6(5):699-705. DOI:10.1089/109662103322515202 · 2.06 Impact Factor