PALLIATIVE CARE IN INTENSIVE CARE UNIT: ANALYSIS OF ONCOLOGICAL PATIENTS PROFILE

Increase incidence of cancer and improvement of treatment led to a better management of these patients in Intensive Care Units (ICU). However, it is known that ICU admission is associated with worse prognosis, depending on the stage of disease, the acute intercurrence and organ failure number. In parallel, it is reported benefit of the integrated assessment of the palliative care team for better treatment. Objectives were to analyze the profile of oncology patients admitted in the ICU who were followed up with the palliative care team, evaluate the main changes adopted and outcomes. It is an observational, retrospective and descriptive study through the analysis of medical records during the years of 2015 to 2017. Qualitative characteristics were described with absolute and relative frequency, quantitative with summary measures and it was compared with Mann-Whitney test. A total of 67 medical records were analyzed, the majority being female and the mean age was 61.6 years. Breast cancer was the most prevalent followed by ovary and head and neck cancer. Metastatic disease accounted for 86.6% of cases. The main reason for ICU admission was sepsis and the justification for the integrated follow-up was advanced life support limitation and prioritization of comfort treatment. Changes made by the palliative team were adjustment of analgesia, sedation, reduction of hydration and volume of diet and family support. About oncology treatment, 67.2% of patients received chemotherapy, 9% received it in the last 14 days of life and 31% in the last 30 days before the onset of palliative treatment. Mean ICU stay was 14.7 days, interval between admission in the ICU and the beginning of follow-up of palliative team was 9.2 days. About the outcomes, 34.3% of patients were discharged to the ward and 65.7% evolved to death in the ICU. Mann-Whitney test was used for comparative analysis between onset of palliative follow-up and outcome, with a mean of 6 days for discharge and 5.1 days for death, but with no statistical significance. It was verified that patients were admitted in ICU due to acute intercurrences and received recommended treatment. Presence of metastasis was not a limiting factor. However, those who evolve with poor prognostic criteria, such as multiple organ dysfunctions, should be evaluated by the palliative care team with intensivists and oncologists, for symptoms control, family support and to avoid futile life-prolonging measures.