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?

ABSTRACT

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.

RESUMO

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.