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[Care for the terminal cancer patient in a primary care district]
E Olano Espinosa1, J L Alonso Pérez, A Crespo Garzón
1Unidad Docente de Medicina Familiar y Comunitaria, Sector XI, Madrid.
Objective:
To analyse medical care for terminal cancer patients (TCP) in a health district.
Design:
A descriptive, crossover study.
Setting:
primary care in an urban environment.
Patients:
227 patients who died of cancer between January 1994 and June 1995 and who came under the nine primary care teams (PCT) studied.
Measurements And Main Results:
Information bases: mortality records and clinical histories from the PCT.
Variables Studied:
age, sex, type of tumour, date of diagnosis of terminal illness, whether treated or not with morphine and (if so) the doses, place of death and the care activity engendered. Univariant analysis with standard means and deviations for the quantitative variables, frequencies for the qualitative ones and the Chi squared test for comparison. 64% were male. Most common neoplasias were, in order: lung, colon and stomach. 78 patients (49%) received morphine treatment, datum related to age. Average morphine dose was 80 mg in 24 hours.
Conclusions:
Patient treatment was inadequate because morphine, the lodestone of terminal cancer care, was insufficiently used. In contradiction with WHO recommendations, most patients died in hospital. Specific training programmes should be created for PC professionals with the aim of improving their handling of terminal cancer patients.