42 cuidados paliativos em onco
Transcript of 42 cuidados paliativos em onco
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Distribuição das taxas de incidência de todas as Neoplasias (C00-C96 exceto pele), ajustadas por idade*, segundo o RCBP e período de referência dos dados.
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* For those free of cancer at beginning of age interval.
Source: DevCan: Probability of Developing or Dying of Cancer Software, Version 6.3.0 Statistical Research and Applications Branch, NCI, 2008. http://srab.cancer.gov/devcan
Lifetime Probability of Developing Cancer, Men, 2003-2005*
† All Sites exclude basal and squamous cell skin cancers and in situ cancers except urinary bladder .
Site Risk
All sites† 1 in 2
Prostate 1 in 6
Lung and bronchus 1 in 13
Colon and rectum 1 in 18
Urinary bladder‡ 1 in 27
Melanoma§ 1 in 39
Non-Hodgkin lymphoma 1 in 45
Kidney 1 in 57
Leukemia 1 in 67
Oral Cavity 1 in 72
Stomach 1 in 90
‡ Includes invasive and in situ cancer cases§ Statistic for white men.
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Lifetime Probability of Developing Cancer, Women, US, 2003-2005*
Site Risk
All sites† 1 in 3
Breast 1 in 8
Lung & bronchus 1 in 16
Colon & rectum 1 in 20
Uterine corpus 1 in 40
Non-Hodgkin lymphoma 1 in 53
Urinary bladder‡ 1 in 84
Melanoma§ 1 in 58
Ovary 1 in 72
Pancreas 1 in 75
Uterine cervix 1 in 145
Source: DevCan: Probability of Developing or Dying of Cancer Software, Version 6.3.0 Statistical Research and Applications Branch, NCI, 2008. http://srab.cancer.gov/devcan
* For those free of cancer at beginning of age interval. † All Sites exclude basal and squamous cell skin cancers and in situ cancers except urinary bladder .‡ Includes invasive and in situ cancer cases§ Statistic for white women.
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US Mortality, 2006
*Includes nephrotic syndrome and nephrosis.Source: US Mortality Data 2006, National Center for Health Statistics, Centers for Disease Control and Prevention, 2009.
• 1. Heart Diseases 631,636 26.0• • 2. Cancer 559,888 23.1
• 3. Cerebrovascular diseases 137,119 5.7• • 4. Chronic lower respiratory diseases 124,583 5.1• • 5. Accidents (unintentional injuries) 121,599 5.0• • 6. Diabetes mellitus 72,449 3.0• • 7. Alzheimer disease 72,432 3.0• • 8. Influenza & pneumonia 56,326 2.3• 9. Nephritis* 45,344 1.9
• 10. Septicemia 34,234 1.4
Rank Cause of DeathNo. of deaths
% of all deaths
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Change in US Death Rates* from 1991 to 2006
* Age-adjusted to 2000 US standard population.Sources: US Mortality Data, National Center for Health Statistics, Centers for Disease Control and Prevention, 2009.
17,8
63,3
34,8
313,0
215,1
43,6
180,7200,2
0
100
200
300
400
Heart diseases Cerebrovasculardiseases
Influenza &pneumonia
Cancer
1991
2006
Rate Per 100,000
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• Assistente Social
• Enfermagem durante a II guerra
• Medicina aos 33
• O conceito da dor total
"We have to concern ourselves with the quality of life as well as its length,"
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COMPORTAMENTO COMPORTAMENTO DOLOROSODOLOROSO
SOFRIMENTOSOFRIMENTO
DOR
NOCICEPÇÃONOCICEPÇÃO
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(Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment)
JAMA 274, 1995
• Pacientes com alto risco de morte
• Objetivo:– Melhorar a capacidade de decisão em casos
terminais e reduzir a freqüência: - suporte mecânico, - dor, - prolongamento do processo do morrer
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• Os médicos não estão atentos aos desejos de seus pacientes de não-ressuscitar em 53% dos casos.
• Metade dos pacientes passam uma ou mais semanas no CTI em coma ou com respirador.
• 50% dos pacientes sofrem de dores moderadas a severas durante os seus 3 últimos dias.
• 31% das famílias perdem toda ou a maior parte de suas economias durante essa fase.
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• O sistema não sabe quando ou como parar.• Prognóstico – nós, geralmente, não sabemos
até que seja muito tarde:– Quando uma doença é fatal,– Quando alguém está morrendo,
• É muito freqüente morrermos sós, com dor e ligados a máquinas.
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Novo Conceito de Cuidado Paliativo:Adaptação de Lynn and Adamson, 2003
Modelo Antigo Modelo Atual
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“No doente oncológico em fase finalmais vale dar vida aos dias
que dias à vida”
Raul Marchezani – 1953Raul Marchezani – 1953Araras - SPAraras - SP
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