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Master's Dissertation
DOI
https://doi.org/10.11606/D.85.2022.tde-10032023-152516
Document
Author
Full name
Anna Lydia Mol Villela
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2022
Supervisor
Committee
Zeituni, Carlos Alberto (President)
Fernandes, Marco Antonio Rodrigues
Karam Junior, Dib
Title in Portuguese
Avaliação de escores preditores de mortalidade em pacientes com tumor sólido em um centro de Cuidados Paliativos
Keywords in Portuguese
Cuidados Paliativos
estimativa clínica de sobrevida
Palliative Prognostic Index
Palliative Prognostic Score
prognóstico
Abstract in Portuguese
Prever a expectativa de vida em pacientes com câncer em Cuidados paliativo (CP) é ainda um grande desafio. Os modelos de avaliações prognósticas são calibrados para populações específicas. É essencial identificar a ferramenta que melhor se adapte a cada cenário clínico. Trata-se de um estudo de coorte, prospectivo com pacientes portadores de neoplasias sólidas em fase avançada, em um hospital oncológico, com o objetivo de avaliar os escores prognósticos PaP (Palliative Prognostic Score), PPI (Índice de prognóstico paliativo) e estimativa clínica de sobrevida (ECS). Analisou-se a sobrevida observada e comparou-se com essas ferramentas. O tempo de sobrevida foi definido como a diferença em semanas entre o dia da primeira consulta e óbito do paciente. Para as análises estatísticas, utilizou-se um nível de significância de 5% e um intervalo de confiança de 95%. Foram incluídos 88 pacientes no estudo. O tempo médio entre o diagnóstico e o encaminhamento aos CPs foi de 84 semanas. A mediana da duração de seguimento na Unidade de CP foi de 16 semanas (sobrevida observada). A maior parte dos pacientes foi categorizada no Grupo A, tanto no escore PaP quanto no PPI. As sensibilidades calculadas para os escores da categota A, PaP e PPI, e para ECS acima de 12 semanas foram de 96,2%, 84,4%, e 68,6 %, respectivamente. A especificidade nos escores PPI e PaP foram maiores para as categorias que estimavam menor sobrevida. Quanto à ECS, a especificidade foi maior no intervalo de 11 a 12 semanas (98,6%). A acurácia do PaP para categoria A foi superior aos demais escores, reforçando o pressuposto de que o escore é mais assertivo para pacientes com expectativa de vida mais alta. Concluiu- se, para a presente amostra, que o escore PAP na categoria A se mostrou a melhor ferramenta para prever a sobrevida de pacientes.
Title in English
Assessment of mortality predictor scores in patients with solid tumor in a Palliative Care center
Keywords in English
clinical prediction of survival
Palliative Care
Palliative Prognostic Index
Palliative Prognostic Scale
prognosis
prognostic score
Abstract in English
Predict the life expectancy y of patients with cancer in palliative care (PC) unit remains a major challenge. Prognostic assessment models have been calibrated for specific populations, and it is important to identify the tool that best fits each clinical scenario. This prospective cohort study included patients with late-stage solid malignant tumors at an oncology hospital - a reference center in eastern Minas Gerais state, Brazil. The aim of the study was to evaluate the Palliative Prognostic Score (PaP) and the Palliative Prognostic Index (PPI) and to compare their performance with the clinical prediction of survival (CPS) and actual patient survival. The PaP, PPI, and CPS scores were calculated at the initial consultation. Subsequently, the observed survival was analyzed and compared with these scores. Survival time was defined as the difference (in weeks) between the day of the first visit and the day of the patient's death. A 5% level of significance and a 95% confidence interval were used for statistical analyses. Overall, 88 patients were included in the study. The mean time between diagnosis and referral to the PC unit was 84 weeks, and the median duration of follow-up in the PC unit was 16 weeks (observed survival). Most patients were classified under Category A based on their PaP and PPI scores. The calculated sensitivity for the Category A scores, i.e., PaP and PPI, and the CPS score over 12 weeks was 96.2%, 84.4%, and 68.6%, respectively. Notably, the specificity for the PPI and PaP scores was higher for the categories that estimated shorter survival time. In terms of the CPS score, the specificity was highest in the 1112-week interval (98.6%). The accuracy of the PaP score for Category A was higher than that of the other scores, reinforcing the notion that this score is a better indicator of survival in patients with longer life expectancies. It was concluded that the PaP score in Category A was the best tool for predicting patient survival in the present study group.
 
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Publishing Date
2023-03-16
 
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