緩和ケアと医学

抽象的な

Needs for Palliative Care of Cancer Patients in Brazil: Analysis of Data from 2008-2014

Cledy Eliana dos Santos*, José Manuel Peixoto Caldas, José Américo Serafim, Newton Barros, Altamiro da Costa Pereira, Marcelo Eduardo Zanella Capra and Airton Stein

Background: The Brazilian Health System (SUS) faces major challenges to ensure the constitutional right of universal access to health care assistance and technological advances to the entire population. Concerns with the ageing population, the increasing incidence of cancer and the emergence of chronic non-communicable diseases include palliative care as one of the objectives of the Brazilian Health System (SUS). However, considering that each disease and individual present different social and cultural factors, needs, pattern of disease progression, associated co-morbidities and access to health care, the estimation of necessary resources and the definition of specific criteria to structure and adapt palliative care in the health services have been a difficult task in Brazil. Thus, it is necessary to estimate the needs and the resources and to specify parameters to structure and tailor an adequate modality of assistance in palliative care. Aims: 1) To estimate the number of cancer patients with palliative care needs in the population; 2) To simulate palliative care methods for population based estimation. Methods: The present methodology has a quantitative approach, with descriptive, exploratory, retrospective and observational studies of hospitalized cancer patients. This is a cross-sectional study using death certificate and hospital admission data, which was collected from the Mortality Information System (SIM) and Hospital Information System (SIH) of the Brazilian Health System (SUS), obtained from the database of the Health Information Department (DATASUS). Results: Yearly around 1.1 million deaths were reported to the Brazilian Mortality Information System, being 15.9% of these related to people living with cancer. Between 2008 and 2014, there were almost 4.5 million hospitalizations (4,431,685) of patients with cancer in Brazil, and, of all the hospital admissions of cancer patients, 1.189.908 (26.85%) were related to intercurrences of the disease and/or of treatment. The average rate of hospital mortality was 7.7 for cancer in general and 21.4 for clinical intercurrence of cancer patients, while the average length of stay (LOS) was 5.7 days for cancer in general and 7.9 days for clinical intercurrence of cancer patients. Conclusion: considering that the offer and the technical guidance regarding palliative care for users served by health establishments authorized by Brazilian Health System for the specialized assistance in oncology are mandatory, we need to estimate the needs, resources and specify parameters to structure and tailor an adequate modality of assistance in palliative care.