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OBJECTIVE: To compare factors associated with death in adults and older people with advanced cancer who were hospitalized in a palliative care unit (PCU). METHODS: Case-control study with patients (adults vs older people) admitted to a PCU of National Cancer Institute José Alencar Gomes da Silva (INCA), in Rio de Janeiro, Brazil. Logistic regressions (odds ratio [OR] and 95% confidence interval [95%CI]) were used to identify factors associated with death. RESULTS: The study included 205 patients, most of which were aged over 60 years old (60.5%). Among the adult patients, a Karnofsky Performance Status ≤ 40% (OR 2.54 [95%CI 1.11–3.45]) and neutrophil-to-lymphocyte ratio (NLR) (OR 1.09 [95%CI 1.02–1.24]) were risk factors for death, while albumin (OR 0.30 [95%CI 0.12–0.78]) was a protective factor. Among older patients, NLR (OR: 1.13 [95%CI 1.02–1.24]), C-reactive protein (CRP) (OR 1.09 [95%CI 1.02–1.17]), modified Glasgow Prognostic Score (mGPS) 1 and 2 (OR 4.66 [95%CI 1.35–16.06]), CRP-to-albumin ratio (CAR) (OR 1.27 [95%CI 1.03–1.58]), and nutritional risk (OR 1.11 [95%CI 1.03–1.19]) were risk factors, whereas albumin (OR 0.23 [95%CI 0.09–0.57]) was a protective factor against death. CONCLUSIONS: Prognostic factors differed between groups. The NLR was a risk factor, and albumin was a protective factor regarding death in both groups. Additionally, CRP, mGPS, CAR, and nutritional risk were associated with an increased risk of death only among older people.

Objective To describe overall survival (OS) in 90 days and to evaluate the prognostic factors in patients with advanced cancer and COVID-19. Methods This is a retrospective cohort study carried out at the Palliative Care Unit of the Brazilian National Cancer Institute. Patients with advanced cancer and COVID-19 confirmed by Reverse Transcription Polymerase Chain Reaction were included. Kaplan-Meier’s curves, log-rank test, and Cox regression were performed. Results Eighty-three inpatients were selected. The average age was 61.4 (±12.6) years, with a higher proportion of women (73.4%). The most prevalent tumor type was breast (36.7%), followed by gastrointestinal tract (20.3%). The OS was 32 [interquartile range (IQR): 6–70] days, and at the end of the follow-up period, 17 patients (20.5%) were alive and 66 (79.5%) had died. Patients with advanced cancer and COVID-19 and who were 60–74 years old [hazard ratio (HR): 2.03; 95% confidence interval (CI): 1.09–3.78], with lung tumors (HR: 17.50; 95% CI: 1.70–28.34), with lung metastasis (HR: 4.21; 95% CI: 2.17–8.15), and with chronic obstructive pulmonary disease (HR: 4.92; 95% CI: 1.01–24.69) had higher risk of death in 90 days. Conclusion The age of 60–74 years old, lung tumors (primary or metastases), and the presence of chronic obstructive pulmonary disease were considered independent prognostic factors in patients with advanced cancer and COVID-19.

Background: Advanced cancer patients are part of a group likely to be more susceptible to COVID-19. Aims: To describe the profile of advanced cancer inpatients to an exclusive Palliative Care Unit (PCU) with the diagnosis of COVID-19, and to evaluate the factors associated with death in these cases. Design: Retrospective cohort study with data from advanced cancer inpatients to an exclusive PCU, from March to July 2020, with severe acute respiratory syndrome. Diagnostic of COVID-19 and death were the dependent variables. Logistic regression analyses were performed, with the odds ratio (OR) and 95% confidence interval (CI). Results: One hundred fifty-five patients were selected. The mean age was 60.9 (±13.4) years old and the most prevalent tumor type was breast (30.3%). Eighty-three (53.5%) patients had a diagnostic confirmation of COVID-19. Having diabetes mellitus (OR: 2.2; 95% CI: 1.1-6.6) and having received chemotherapy in less than 30 days before admission (OR: 3.8; 95% CI: 1.2-12.2) were associated factors to diagnosis of COVID-19. Among those infected, 81.9% died and, patients with Karnofsky Performance Status (KPS) < 30% (OR: 14.8; 95% CI 2.7-21.6) and C-reactive protein (CRP) >21.6mg/L (OR: 9.3; 95% CI 1.1-27.8), had a greater chance of achieving this outcome. Conclusion: Advanced cancer patients who underwent chemotherapy in less than 30 days before admission and who had diabetes mellitus were more likely to develop Coronavirus 2019 disease. Among the confirmed cases, those hospitalized with worse KPS and bigger CRP were more likely to die.

Introduction: Sick persons need doctors who understand their pathology, know how to treat their problem, and accompany them through their illness. This study aimed to synthesize the state of knowledge regarding the concept of value-based medicine (VBM) through an integrative literature review, and establish how VBM can be applied in palliative care. Areas covered: An integrative review was conducted with the keywords 'value-based medicine,' 'patient-centered care,' and 'medicina baseada em valor' (Portuguese for VBM) in PubMed and Virtual Health Library, identifying 17,189 articles in total. Of these, 10 articles met the eligibility criteria. VBM combines the highest level of technical-scientific data with patients' values. It is defined as the combination of evidence-based medicine, patient-centered care, and cost-effectiveness. Patients' values are a set of preferences, concerns, and expectations that contribute toward accommodating their needs in the treatment clinic. Expert opinion: Like VBM, palliative care focuses on patients' values and quality of life, respecting natural limits. The early development of a care plan with active participation of the patient in the face of life-threatening diseases should be encouraged and can bring peace and comfort in a person's final moments.

Context: Due to the need for isolation of inpatients with suspected COVID-19, accuracy in identifying these cases in Emergency Department (ED) has great relevance, especially in Palliative Oncology Care Unit (PCU). Objective: To evaluate the efficiency of clinical criteria adopted to identify suspected cases of COVID-19 by the ED in PCU. Methods: All patients admitted to PCU between April and June 2020 from ED were included. The clinical criteria adopted to identify suspected COVID-19 cases were: being in contact with a suspected or confirmed case less than 14 days ago and / or presenting fever with no defined focus and / or respiratory symptoms not explained by oncological disease and / or suggestive image in radiological examination (if necessary). All suspected cases were submitted to deep nasal and throat swab for SARS COV-2 investigation by Reverse Transcription Polymerase Chain Reaction Test, adopted as gold standard. Inpatients hospitalized by ED, without suspicion, and then diagnosed with COVID-19 within 10 days of hospitalization were considered as false-negative cases. Results: During the period, 327 patients were admitted from ED. Of these, 69 (21%) were considered suspects, of whom 34 (49%) tested positive for COVID-19. The sensitivity of the clinical criterion to identify suspected cases was 87%, specificity was 88%, positive predictive value was 49%, negative was 98% and accuracy was 88%. Conclusion: The clinical criteria adopted to identify suspected cases of COVID-19 at ED proved to be efficient, with low risk of spreading in-hospital infection, avoiding unnecessary isolation of patients.