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Cuidados intensivos, supervivencia y gastos de tratamiento de pacientes con cáncer en estado crítico
D V Schapira1, J Studnicki, D D Bradham
1Section of Cancer Prevention, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612.
JAMA
|February 10, 1993
Resumen
Los pacientes con cáncer en estado crítico ingresados en la unidad de cuidados intensivos (UCI) tienen una supervivencia y tiempo en casa limitados. Este estudio cuantifica el alto costo por año de vida ganado para estos pacientes.
Área de la Ciencia:
- Oncología Oncología.
- Medicina de cuidados críticos Medicina de cuidados críticos.
- Economía de la salud Economía de la salud
Sus antecedentes:
- Los pacientes con tumores sólidos y cánceres hematológicos ingresados en la UCI a menudo tienen malos pronósticos.
- Comprender la supervivencia y la rentabilidad es crucial para la asignación de recursos y las decisiones de atención al paciente.
Objetivo del estudio:
- Determinar las tasas de supervivencia y los factores que influyen en la supervivencia de los pacientes de UCI con cáncer.
- Para evaluar el tiempo pasado en el hogar (supervivencia significativa) antes de la muerte.
- Para calcular el costo por año de vida ganado y por año de vida ganado en el hogar.
Principales métodos:
- Se realizó un análisis de supervivencia y rentabilidad.
- Se recopilaron datos de 83 pacientes con tumores sólidos y 64 con cánceres hematológicos ingresados en la UCI de un centro de cáncer de atención terciaria entre 1988 y 1990.
- Los factores analizados incluyeron la edad, el sexo, el tipo de tumor maligno, la duración de la estancia en la UCI y la necesidad de ventilación mecánica.
Principales resultados:
- La ventilación mecánica fue el único factor significativo que afectó la supervivencia en pacientes con cáncer hematológico.
- Más del 75% de los pacientes pasaron menos de tres meses en casa antes de morir.
- El costo por año de vida ganada fue de $ 82,845 para tumores sólidos y $ 189,339 para cánceres hematológicos; los costos en el hogar fueron significativamente más altos.
Conclusiones:
- La mayoría de los pacientes con cáncer ingresados en la UCI tienen una supervivencia limitada y un tiempo mínimo en el hogar, a un costo financiero sustancial.
- Los médicos deben discutir el pronóstico y la posible retirada del soporte vital con los pacientes y las familias para establecer estrategias de atención adecuadas.
- Esto pone de relieve la necesidad de considerar cuidadosamente los tratamientos agresivos en pacientes con cáncer en estado crítico.
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