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Doctoral Thesis
DOI
https://doi.org/10.11606/T.5.2008.tde-04082008-094818
Document
Author
Full name
Aldo Lourenço Abbade Dettino
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2008
Supervisor
Committee
Negri, Elnara Márcia (President)
Dolhnikoff, Marisa
Garcia, Maria Lucia Bueno
Hoelz, Cristiane
Meyer, Eduardo Correa
Title in Portuguese
Linfangite carcinomatosa: impacto da terapêutica paliativa na qualidade de vida e prognóstico
Keywords in Portuguese
Câncer
Cuidado paliativo
Linfangite
Prognóstico
Pulmão
Qualidade de vida
Abstract in Portuguese
A linfangite pulmonar neoplásica (LPN) é a disseminação intrapulmonar de células neoplásicas metastáticas via vasos linfáticos, englobando 6 a 8% das metástases pulmonares. Seu desconforto sintomático tem grande impacto na qualidade de vida (QdV) e seu prognóstico é muito reservado. Nosso objetivo foi avaliar os aspectos clínicos, o tratamento, a QdV e a sobrevida em LPN, em um estudo prospectivo. O seguimento mediano foi de 32 dias; 79% dos pacientes foram seguidos por menos de 6 meses, devido a evolução desfavorável e óbito. A idade mediana dos pacientes foi de 60,5 anos; 65% eram mulheres. A maioria dos sítios primários de neoplasia foram pulmão e mama (88%). A QdV estava comprometida, mas podiam ter algum benefício terapêutico, especialmente com corticosteróides, e a quimioterapia melhorou a sobrevida. Algumas variáveis foram estatisticamente significantes para predizer o status de sobrevida em um mês: Karnofsky performance scale (KPS)>=60%, hemoglobina(Hb)>=10 g/dL, LPN unilateral, PO2>=60 mmHg, tratamento oncológico sistêmico e sem necessidade de ventilação assistida não-invasiva. Preditores significantes de maior sobrevida mediana foram: KPS>=60%, SpO2>=90%, Hb>=10 g/dL, sem hipoxemia (PO2>=60 mmHg), sem necessidade de oxigenioterapia, tratamento com opióide fraco, tratamento oncológico sistêmico e ausência de ventilação assistida. O tratamento sintomático deve ser ativo, oferecendo melhor QdV aos pacientes e familiares e o tratamento etiológico é importante. As avaliações de QdV facilitam a relação médico-paciente, além da informação prognostica ser crucial para ajudar na definição e planejamento terapêuticos, uma vez que análises de parâmetros de custo-benefício e metas realistas são essenciais para cuidados oncológicos paliativos de boa qualidade, especialmente em síndromes com prognóstico reservado, tal como a LPN.
Title in English
Neoplastic pulmonary lymphangitis (NPL) is the intrapulmonary spread of metastatic neoplasm via lymphatic tissue, and accounts for 6-8% of lung metastasis: symptom distress has great impact on quality of life
Keywords in English
Cancer
Lung
Lymphangitis
Palliative care
Prognosis
Quality of life
Abstract in English
Our objective was to evaluate clinical aspects, treatment, QoL, and survival, in NPL in a prospective study. Median follow-up was of 32 days; 79% percent of patients were followed for less than 6 months, due to bad outcome. Median age was 60.5 years; 65% were female. Most primary tumor sites were lung and breast cancers (88%). QoL was compromised, but could have treatment benefit, especially with corticosteroids, and chemotherapy improved survival. Some variables were statistically significant for predicting survival status in one month, such as: Karnofsky performance scale (KPS)>=60%, hemoglobin>=10 g/dL, unilateral NPL, PO2>=60 mmHg, oncological systemic treatment, and no need for noninvasive assisted ventilation. Significant predictors of longer median survival were: KPS>=60%, SpO2>=90%, hemoglobin>=10 g/dL, without hypoxemia (PO2>=60 mmHg), no need for oxygen therapy, weak opioid treatment, systemic oncological treatment, and absence of assisted ventilation. Symptomatic treatment must be active, offering better QoL to patients and their families, and etiological treatment is important. QoL evaluation facilitates patient-physician relationship, and prognostic information is crucial to help in defining treatment plan, since cost-benefit parameter analysis and realistic goals are essential in good-quality palliative cancer care, especially for syndromes with poor prognosis, such as NPL.
 
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aldocompleta.pdf (433.59 Kbytes)
Publishing Date
2008-08-06
 
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