Exploring factors and trends in place of death by cancer: a population-based study in Brazil.

Background: The place of death profoundly affects end-of-life care quality, particularly in cancer. Assisting individuals at home enhances support, privacy, and control, reducing healthcare costs. This study seeks to elucidate factors associated and trends in place of death by cancer in Brazil. Methods: Using data obtained from the National Mortality Information System, this study extracted tumour topography, sociodemographic characteristics, and the place of death (outcome classified into hospital or home death) by cancer in Brazil from 2002 to 2021. Findings: The analysis included 3,677,415 cases, with 82.3% of deaths occurring in hospitals and 17.7% at home. Most participants were male (53.1%), had gastrointestinal tumours (32.2%), and resided in the Southeastern region (48.7%). Home deaths were more frequent in the Northeastern (30.2%) and Northern (24.8%) regions compared to the Southern (17.1%) and Southeastern (12.2%) regions. A strong inverse correlation was found between home deaths and the Human Development Index of the region. Over the years, there was a reduction in home deaths, followed by a recent increase. Individuals with no formal education, indigenous individuals, and patients from the North, Northeast, and Central-West regions had higher rates of home deaths, while patients with haematological malignancies had lower rates compared to those with gastrointestinal tumours. Interpretation: The minority of deaths by cancer in Brazil occur at home, with distinct trends over time. Home death was associated with regional, racial and educational level differences. Funding: No funding.

Outpatient Palliative Care Program: Impact on Home Death Rate in Brazil.

While the positive impact of early palliative care on the quality of life of cancer patients is well established, there is a noticeable research gap in developing countries. This study sought to determine the impact of an outpatient palliative care (OPC) program on the location of death among patients in Brazil. This was a retrospective study including patients with cancer who died between January 2022 and December 2022 in 32 private cancer centers in Brazil. Data were collected from medical records, encompassing demographics, cancer characteristics, and participation in the OPC program. The study involved 1980 patients, of which 32.3% were in the OPC program. OPC patients were predominantly younger (average age at death of 66.8 vs. 68.0 years old, p = 0.039) and composed of women (59.4% vs. 51.3%, p = 0.019) compared to the no-OPC patients. OPC patients had more home/hospice deaths (19.6% vs. 10.4%, p < 0.001), and participation in the outpatient palliative care program strongly predicted home death (OR: 2.02, 95% CI: 1.54-2.64). Our findings suggest a significant impact of the OPC program on increasing home and hospice deaths among patients with cancer in our sample. These findings emphasize the potential of specialized OPC programs to enhance end-of-life care, particularly in low-resource countries facing challenges related to social and cultural dimensions of care and healthcare access.

Quality of life of physicians in the state of Minas Gerais, Brazil.

Introduction: Studies conducted with physicians from different locations and age groups show a tendency to mental illness and low quality of life in this population. Objectives: To describe the socioeconomic and quality-of-life profile of medical doctors in the state of Minas Gerais, Brazil. Methods: Cross-sectional study. A socioeconomic and quality-of-life questionnaire (World Health Organization Quality of Life instrument-Abbreviated version) was applied in a representative sample of physicians working in the state of Minas Gerais. Non-parametric analyses were used to assess outcomes. Results: The sample was composed of 1,281 physicians, with a mean age of 43.7 years (SD, 11.46) and time since graduation of 18.9 years (SD, 12.1); 12.46% were medical residents, of which 32.7% were in the first year of training. Of the total number of physicians, 66.4% reported feeling overwhelmed and 70.7% were satisfed with their profession. The rate of diagnoses related to depression and anxiety was higher than in the general population. Mean World Health Organization Quality of Life instrument-Abbreviated version score was 60.44±21.72. The analysis of the reported quality-of-life scores showed that younger physicians, especially women, in the first year of residence, with lower income or salary ranges, high workload, and no regular time of obtained lower scores, as well as those who reported diagnoses of depression and/or anxiety. Conclusions: Some socioeconomic factors may influence the quality of life of the study population. Further studies are needed to develop effective social support and health protection actions for these workers.

Introdução: Estudos realizados entre profissionais médicos de diferentes localidades e faixas etárias demonstram uma tendência ao adoecimento mental e à baixa qualidade de vida nessa população. Objetivos: Desenhar o perfil de qualidade de vida de médicos atuantes no estado de Minas Gerais, Brasil. Métodos: Tratou-se de um estudo transversal. Foram utilizados questionários socioeconômico e de qualidade de vida (WHOQOL-Bref, do inglês World Health Organization Quality of Life Instrument-Abbreviated Version) em amostra representativa de médicos atuantes no estado de Minas Gerais, com utilização de análises não paramétricas na avaliação dos desfechos. Resultados: A amostra foi composta de 1.281 médicos, com média de idade de 43,7 anos ± desvio-padrão 11,46 e tempo de formado de 18,9 anos ± 12,1; 12,46% estavam cursando residência médica, entre os quais 32,7% no primeiro ano de treinamento. Do total dos médicos, 66,4% se sentiam sobrecarregados e 70,7% se sentiam satisfeitos com a profissão. Observou-se elevado índice de diagnósticos relacionados à depressão e ansiedade, superior ao encontrado na população geral. A média de pontuação do WHOQOL-Bref foi de 60,44 ± 21,72. A análise das pontuações de qualidade de vida mostrou que os médicos mais jovens, em especial do sexo feminino, em seu primeiro ano de residência, que apresentam renda ou faixas salariais menores, com elevada carga horária de trabalho e sem folgas regulares apresentam pontuação inferior, bem como aqueles que informaram diagnósticos de depressão e/ou ansiedade. Conclusões: Existem fatores socioeconômicos que influenciam positiva ou negativamente na qualidade de vida da população estudada. O aprofundamento nos estudos sobre essa realidade é essencial para o desenvolvimento de ações efetivas e abrangentes de suporte social e de proteção à saúde desses trabalhadores.