緩和ケアと医学

抽象的な

Care for All: Palliative Care Strategy to Provide Intensive Acute Symptom Control Management for Patients with Previously Undiagnosed Terminal Cancer

Silvia Allende-Pérez, Ángel Herrera, Abelardo Meneses, Alejandro Mohar, Jaime De La Garza, and Emma Verástegui

Introduction: Despite the fact that important reforms in the Mexican health system have allowed it to offer coverage to 95% of Mexicans, important differences continue to exist in health service quality. The Fund for Protection Against Catastrophic Expenditures allows people with some types of cancer to receive expensive treatments, however, the timely diagnosis of some neoplasms in primary and secondary stages continues to be inefficient and delayed diagnosis is not rare. The present work describes an strategy model implemented by the Palliative Care Service of the Instituto Nacional de Cacerologia (INCan) in Mexico City to provide acute symptomatic management to individuals with advanced cancer without antineoplastic treatment options. Patients and Methods: Patients considered on preconsultation as patients on a terminal stage of the disease were sent to the Palliative Care team on the very same day. In a process that lasted 3 hours on average, patients and their families received medical, psychological, and nutritional care. Results: From January to December 2010, a total of 564 patients with advanced, terminal-stage cancer without prior antineoplastic management were treated at the palliative care unit. More than half of them were considerably underprivileged, with little to no schooling, and suffering from five or more symptoms at the time of their diagnosis. The majority of them presented fatigue and severe pain, and none had received treatment with strong opioids. Average survival was 36.6 days. Conclusion: Timely diagnosis of cancer continues to be an important challenge for the Mexican health system, a pattern that is, understandably, most notable amongst the patients living in poverty. The model implemented at the Institution avoids costly, unnecessary treatments, affording patients and their families’ specialized, humanitarian, and ethical care.