Utilization of medical interventions in hospitalized Mexican adults with cancer at the end of life in a referral hospital: The importance of early palliative care.

OBJECTIVES: To investigate the impact of early vs. late palliative care (PC) on the frequency of admissions to acute hospital settings and the utilization of end-of-life (EoL) interventions in cancer decedents. METHODS: In this single-center, cross-sectional study, we examined the frequency of intensive care unit (ICU) and emergency department (ED) admissions among adult cancer decedents between 2018 and 2022 in a referral hospital in México. Additionally, we assessed EoL medical interventions, categorizing patients into 3 groups: those who received early PC (EPC), late PC (LPC), and those who did not receive PC (NPC). RESULTS: We analyzed data from 1762 patients, averaging 56 ± 16.3 years old, with a predominant representation of women (56.8%). PC was administered to 45.2% of patients, but EPC was limited to only 12.3%. The median time from the initiation of PC to death was 5 days (interquartile range: 2.0-31.5). Hematological malignancies were the most prevalent, affecting 21.5% of patients. EPC recipients demonstrated notable reductions in ICU and ED admissions, as well as diminished utilization of chemotherapy, radiotherapy (RT), antibiotics, blood transfusions, and surgery when compared to both LPC and NPC groups. EPC also exhibited fewer medical interventions in the last 14 days of life, except for RT. SIGNIFICANCE OF RESULTS: The findings of this study indicate that a significant proportion of EoL cancer patients receive PC; however, few receive EPC, emphasizing the need to improve accessibility to these services. Moreover, the results underscore the importance of thoughtful deliberation regarding the application of EoL medical interventions in cancer patients.

Palliative Care in Patients With Hematological Malignancies. We Have a Long Way to Go .

Background: Patients with hematological malignancies have significant and diverse palliative care needs but are not usually referred to specialist palliative care services in a timely manner, if at all. Objective: To identify the characteristics of patients with hematological malignancies referred to the palliative care service in a tertiary hospital in Mexico City. Patients: Retrospective study including consecutive patients with hematological malignancies referred to palliative care services at Mexico's National Cancer Institute. Results: Between 2011 and 2019, 5,017 patients with hematological malignancies were evaluated for first time at Mexico's National Cancer Institute. Of these, 9.1% (n = 457) were referred to palliative care. Most were male (53.4%), with a median age of 58 years. The most frequent diagnosis was non-Hodgkin lymphoma (54.9%). The primary indication for referral to palliative care was for cases wherein chemotherapy was no longer an option (disease refractory to treatment, 42.8%). The median time of referral to the palliative care service occurred 11.2 months after the first evaluation at the National Cancer Institute and death occurred on median 1.1 months after the first palliative care evaluation. Conclusion: Patients with hematological neoplasms are infrequently referred to Palliative Care at the Institute (9.1%). We found no clear referral criteria for Palliative Care referral and note that hematologists' optimism regarding a cure can delay referrals. Clearly, we have a long way to go in improving the number of patients referred, and we still saw frequent referrals near the end of life, but the high rate of outpatient referrals is encouraging.

Profile, Treatment, and Survival of Palliative Cancer Patients in a Middle Income Country's Cancer Center.

BACKGROUND: Data describing the characteristics, treatment, and survival of oncological patients referred to PCS remains scarce. Aim: To establish the characteristics of oncological patients referred to PCS, including their profile, treatment, and survival within a 7-year period. DESIGN: Retrospective review of medical records. Clinical variables such as treatment and dates were included. Ji2 or Wilcoxon tests were used accordingly; Kaplan-Meier and log rank test were used to estimate survival. SETTING/PARTICIPANTS: Consecutive oncological patients diagnosed between 2012 and 2018 sent to PCS were included. RESULTS: We studied 5,631 patients, 58% female and 59% at advanced stage. Median age was 59 years, with 6 years or less of formal education and low monthly income ($152.4 USD). Neoplasms included breast (12%), stomach (12%), colorectal (10%) and cervical cancer (9%). Median referral time was 5.1 months; pain was the main reason for referral. Morphine was the most prescribed opioid with 47%. Median overall survival was 3.1 months. CONCLUSIONS: Morphine remains the paradigm of treatment making necessary to emphasize information on its optimal use. Additional measures such as education for cancer prevention and early referral to PCS are vital to improve survival and quality of life.

Conocimientos básicos y percepciones en cuidados paliativos en médicos de pregrado de la Universidad Nacional Autónoma de México: un estudio transversal / Basic knowledge and perceptions of palliative care among undergraduate physicians at the National Autonomous University of Mexico: a cross-sectional study

ANTECEDENTES Y OBJETIVO: La OMS considera que, para la integración exitosa de los cuidados paliativos (CP) a la sociedad, es necesaria la educación de los profesionales de la salud y la población en general. Sin embargo, es escasa la información sobre conocimientos de los estudiantes de pregrado de medicina en CP. Este estudio explora el nivel de conocimientos y capacidades de estudiantes de pregrado de medicina para afrontar situaciones al final de la vida de sus pacientes. MATERIALES Y MÉTODOS: Estudio transversal en estudiantes entre enero y febrero de 2015. Se evaluaron los conocimientos básicos y las percepciones sobre la atención de pacientes al final de la vida, en estudiantes de medicina de pregrado utilizando un cuestionario anónimo. El análisis estadístico fue descriptivo y bivariado. RESULTADOS: Se incluyeron 726 participantes con una tasa de respuesta de 82,5 %. La mayoría mujeres (60,8 %), con una mediana de edad de 24 años (23-25). Los CP se definieron como "calidad de vida" en 38,6 % (n = 280). El 63,4 % consideró no ser capaz de manejar el paciente al final de la vida y el 78,4 % se sintió moderadamente capaz de dar malas noticias; el 65,7 % no tuvo entrenamiento en CP y el 88,2 % consideró necesario incluir esta materia en su programa de estudios. CONCLUSIONES: Los resultados muestran algunas necesidades en el área de CP en estudiantes de pregrado de medicina y baja autopercepción de capacidades para afrontar situaciones al final de la vida de los pacientes, así como el interés de incluir la asignatura obligatoria de CP

BACKGROUND AND OBJECTIVE: The WHO considers that, for a successful integration of PC in society, education of health professionals and the general population is necessary. However, information on the knowledge undergraduate medical students have on PC is scarce. This study explores the level of knowledge and skills of medical undergraduate students to face situations at the end of their patients' lives. MATERIALS AND METHODS: A cross-sectional study in Mexican students between January and February 2015. The basic knowledge and perceptions of patient care at the end of life were evaluated in undergraduate medical students using an anonymous questionnaire. The statistical analysis was descriptive and bivariate. RESULTS: A total of 726 participants were included with a response rate of 82.5 %. The majority were women (60.8 %), with a median age of 24 years (23-25). PC was defined as "quality of life" by 38.6 % (n = 280), 63.4 % considered themselves unable to handle patients at the end of life, and 78.4 % felt moderately capable of breaking bad news; 65.7 % had no training in PC and 88.2 % considered it necessary to include this subject in their curriculum. CONCLUSIONS: The results reveal important unsatisfied needs in the area of PC among medical undergraduate students, and a low self-perception of their abilities to face situations at the end of a patient's life, as well as the interest of including CP as a compulsory subject

Assessment and Impact of Phase Angle and Sarcopenia in Palliative Cancer Patients.

Sarcopenia has been evaluated as a separate condition in cancer patients and as an important indicator of adverse outcomes. Muscle mass and phase angle are usually quantified by bioelectrical impedance analysis, due to its lower cost, and availability. The aim of this study was to assess the impact of sarcopenia, phase angle, and other characteristics on overall survival (OS) in palliative cancer patients at the National Cancer Institute of Mexico. We enrolled 628 patients (female, 59%). The most frequent disease was gastric cancer (39.5%). Kaplan-Meier analysis showed a significant survival disadvantage for patients with sarcopenia compared to patients without sarcopenia (p = 0.02). Sarcopenia univariably predicted OS [HR 1.4 (95% CI, 1.1-1.8), p = 0.001], but was not significant in multivariable Cox-regression analysis (p = 0.08). Significant predictors for sarcopenia in multivariable Cox-regression analysis were sex, age, body mass index, phase angle, clinical symptoms, and Karnofsky. Our results corroborate the reliability of sarcopenia and phase angle in Mexican population, showing that the measurement of these parameters might also be useful in early-stage cancer patients as prognostic markers.

Integrated oncology and palliative care: five years experience at the National Cancer Institute of Mexico.

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.

Integrated oncology and palliative care: five years experience at the National Cancer Institute of Mexico / Oncología integrada y cuidados paliativos: experiencia de cinco años en el Instituto Nacional de Cancerología en México

Abstract 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.

Resumen En 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.

[Anorexia-cachexia frequency and its gastrointestinal symptoms association in paliative patients at the Instituto Nacional de Cancerología, México]. / Frecuencia de anorexia-caquexia y su asociación con síntomas gastrointestinales, en pacientes paliativos del Instituto Nacional de Cancerología, México.

BACKGROUND: Anorexia-cachexia is a frequent syndrome among cancer patients, specially in late stages: the global prevalence of para-neoplastic anorexia-cachexia ranges between 20-40% in the diagnostic stage and between 70-80% in the late stage of the disease. The co-existence of functional or structural digestive abnormalities is frequently observed among cancer patients; this is a consequence of the tumor growth and of those systemic phenomena related to metabolism, which are affected by the relationship tumor-host specific to anorexia- cachexia. OBJECTIVE: This study aimed at establishing the frequency of anorexia-cachexia, as well as its relationship to GI symptoms in the context of palliative care patients at the Instituto Nacional de Cancerología, México City. METHODS AND MATERIAL: Analytic cross-sectional study including 100 patients diagnosed with late-stage cancer, age range 18-80, and a Karnofsky score > 50, as well as an ECOG <2; patients with a bad general health status were not allowed in the study. After reviewing inclusion and exclusion criteria, participants fulfilled the FAACT questionnaire, as well as the EGS. Patients recruitment was carried out by the Instituto Nacional de Cancerología. Results and discussion: Results show that 61% (n=61)of the patients had anorexia-cachexia, and 39% (n=39)did not. 56% of the sample participants (n=34) were women, and 44% (n=27) were men. GI symptoms associated with anorexia-cachexia were: nausea (p= 0.0001), vomiting (p=0.004), early satiety (p=0.0005), dysgeusia(p=0.0005) and dysphagia (p=0.001). CONCLUSION: Anorexia and cachexia are among the most devastating and frequent symptoms in late-stage cancer patients and they are also associated with GI symptoms affecting the physical, psychosocial and existential aspects of the patient's life. Data from this research validate the importance of an early nutrition support in palliative patients so that they can achieve a better quality of life.

Introducción: La anorexia-caquexia es un síndrome frecuente en pacientes oncológicos, particularmente en etapas avanzadas: la prevalencia global de anorexia-caquexia para-neoplásica oscila entre el 20-40% en los enfermos en la fase diagnóstica, y entre el 70­80% en la fase avanzada de la enfermedad. En los enfermos oncológicos es frecuente la coexistencia de alteraciones digestivas estructurales o funcionales, secundarias al crecimiento tumoral y a los fenómenos sistémicos de carácter metabólico, determinados por la interrelación tumor-huésped específicos de la anorexia-caquexia. Objetivo: El objetivo de este trabajo es conocer la frecuencia de anorexia-caquexia, y su asociación con síntomas gastrointestinales en pacientes en terreno paliativo del Instituto Nacional de Cancerología, Ciudad de México, atendidos en el servicio de Cuidados Paliativos. Material y métodos: Se realizó un estudio transversal analítico. Se incluyeron 100 pacientes con diagnóstico de cáncer avanzado, con un rango de edad de 18 y 80 años, y una puntuación de Karnofsky > 50, así como un ECOG.

Frecuencia de anorexia-caquexia y su asociación con síntomas gastrointestinales, en pacientes paliativos del Instituto Nacional de Cancerología, México / Anorexia-cachexia frequency and its gastrointestinal symptoms association in paliative patients at the Instituto Nacional de Cancerología, México

Introducción: La anorexia-caquexia es un síndrome frecuente en pacientes oncológicos, particularmente en etapas avanzadas: la prevalencia global de anorexia-caquexia para-neoplásica oscila entre el 20-40% en los enfermos en la fase diagnóstica, y entre el 70-80% en la fase avanzada de la enfermedad. En los enfermos oncológicos es frecuente la coexistencia de alteraciones digestivas estructurales o funcionales, secundarias al crecimiento tumoral y a los fenómenos sistémicos de carácter metabólico, determinados por la interrelación tumor-huésped específicos de la anorexia-caquexia. Objetivo: El objetivo de este trabajo es conocer la frecuencia de anorexia-caquexia, y su asociación con síntomas gastrointestinales en pacientes en terreno paliativo del Instituto Nacional de Cancerología, Ciudad de México, atendidos en el servicio de Cuidados Paliativos. Material y métodos: Se realizó un estudio transversal analítico. Se incluyeron 100 pacientes con diagnóstico de cáncer avanzado, con un rango de edad de 18 y 80 años, y una puntuación de Karnofsky > 50, así como un ECOG <2; se excluyeron aquellos pacientes con mal estado general y que rechazaron participar en el estudio. Posterior a revisar los criterios de inclusión y exclusión, se les aplicó el cuestionario FAACT, así como la EGS. La institución que reclutó a los pacientes fue Instituto Nacional de Cancerología. Resultados y discusión: Los resultados muestran que el 61% (n=61) de los pacientes presentó anorexia-caquexia, mientras que no ocurrió así para el 39% (n=39). Al grupo de mujeres correspondió el 56% de la muestra (n=34), mientras que al de los hombres el 44% (n=27). Los síntomas gastrointestinales que se asociaron con la anorexia-caquexia, fueron: náusea (p= 0.0001), vómito (p=0.004), saciedad temprana (p=0.0005), disgeusia (p=0.0005) y disfagia (p=0.001). Conclusión: La anorexia y la caquexia se encuentran entre los síntomas más devastadores y habituales en pacientes con cáncer avanzado y a su vez se encuentran asociadas a síntomas gastrointestinales que afectan la esfera física, psicosocial y existencial del paciente. Con los datos obtenidos del presente estudio, se corrobora la relevancia que tiene la atención nutricional temprana en los pacientes paliativos para que logren una mejor calidad de vida (AU)

Background: Anorexia-cachexia is a frequent syndrome among cancer patients, specially in late stages: the global prevalence of para-neoplastic anorexia-cachexia ranges between 20-40% in the diagnostic stage and between 70-80% in the late stage of the disease. The co-existence of functional or structural digestive abnormalities is frequently observed among cancer patients; this is a consequence of the tumor growth and of those systemic phenomena related to metabolism, which are affected by the relationship tumor-host specific to anorexia-cachexia. Objective: This study aimed at establishing the frequency of anorexia-cachexia, as well as its relationship to GI symptoms in the context of palliative care patients at the Instituto Nacional de Cancerología, México City.Methods and material: Analytic cross-sectional study including 100 patients diagnosed with late-stage cancer, age range 18-80, and a Karnofsky score > 50, as well as an ECOG <2; patients with a bad general health status were not allowed in the study. After reviewing inclusion and exclusion criteria, participants fulfilled the FAACT questionnaire, as well as the EGS. Patients recruitment was carried out by the Instituto Nacional de Cancerología. Results and discussion: Results show that 61% (n=61) of the patients had anorexia-cachexia, and 39% (n=39) did not. 56% of the sample participants (n=34) were women, and 44% (n=27) were men. GI symptoms associated with anorexia-cachexia were: nausea (p= 0.0001), vomiting (p=0.004), early satiety (p=0.0005), dysgeusia (p=0.0005) and dysphagia (p=0.001). Conclusion: Anorexia and cachexia are among the most devastating and frequent symptoms in late-stage cancer patients and they are also associated with GI symptoms affecting the physical, psychosocial and existential aspects of the patient’s life. Data from this research validate the importance of an early nutrition support in palliative patients so that they can achieve a better quality of life (AU)

Creencias, actitudes y ansiedad ante la muerte en un equipo multidisciplinario de cuidados paliativos oncológicos / Beliefs, attitudes, death anxiety in a multidisciplinary team oncology palliative care

En el ámbito de la salud, se ha puesto en evidencia la necesidad de profundizar en las actitudes y creencias ante la muerte en los propios profesionales ya que pueden influir en la calidad de los cuidados, especialmente las derivadas de procesos de muerte y duelo, por lo que el objetivo de la investigación fue explorar y analizar actitudes y creencias ante la muerte en el personal de salud en Cuidados Paliativos Oncológicos. Fue un estudio, transversal y descriptivo; se utilizó un muestreo intencional, los instrumentos utilizados fueron: Formato de datos personales y profesionales, Escala de Ansiedad ante la muerte de Templer, Creencias con relación al paciente terminal y Cuestionario de Actitudes ante la Muerte (CAM). Se analizaron los datos estadísticamente: análisis de frecuencias y correlación de Spearman, con una alta tendencia en considerar que es mejor que el paciente terminal fallezca en casa, en el uso de la morfina como tratamiento para el dolor en cáncer avanzado y recibir una atención integral. Dentro de las principales actitudes del personal de salud hacia el paciente terminal y la muerte se encontraron: mayor responsabilidad y atención hacia la vida, y promoción del crecimiento personal para aceptar su propia muerte

In the field of health, has highlighted the need to delve into the attitudes and beliefs about death in the professionals because they can influence the quality of care, especially those derived from processes of death and mourning, for what the objective of the research was to explore and analyze attitudes and beliefs about death in health personnel Oncology Palliative Care. The study was a cross-sectional and descriptive, purposive sampling was used, the instruments used were format personal and professional, Anxiety Scale Templer’s death, beliefs regarding the terminal patient and Attitudes Questionnaire Death (CAM ). Data were analyzed statistically: Frequency analysis and Spearman correlation, with a high tendency to consider that is better than the terminal patient dies at home, in the use of morphine as a treatment for pain in advanced cancer and receiving comprehensive care. Among the main attitudes in the health staff towards the patient and death were found: more responsibility and attention to the promotion of life and personal growth to take his own life

Cimetidina en el tratamiento de herpes zoster / Cimentidine in herpes zoster treatment

En un estudio prospectivo realizado en el Instituto Nacional de Cancerología, se randomizaron pacientes con diagnóstico clínico de Herpes Zoster, para recibir: Cimetidina 300 mg. V.O.c/6 hrs. ó Vitamina B1 (placebo) V.O. c/6 hrs. La Cimetidina mejoró significativamente el dolor y la cicatrización. No se encontraron efectos adversos. La Cimetidina parece ser un método eficaz y económico en el tratamiento de Herpes en pacientes con Neoplasia