Palliative Care in Brazil: With a View to Future Needs?

Revista da Associação Médica Brasileira

SUMMARY OBJECTIVE: To estimate the human resources and services needed to meet the demand of the Brazilian population who would benefit from palliative care, based on the population growth projection for 2040. METHODS: Population and mortality estimates and projections were obtained from the Brazilian Institute of Geography and Statistics. Service needs were estimated based on literature data. RESULTS: The expected increase in the Brazilian population for 2000-2040 is 31.5%. The minimum estimate of patients with palliative care needs was 662,065 in 2000 and 1,166,279 in 2040. The staff required for each hundred thousand inhabitants would increase from 1,734 to 2,282, the number of doctors needed would increase from 4,470 to 6,274, and the number of nurses from 8,586 to 11,294, for the same period. CONCLUSION: The definition of a national strategy predicting the increasing palliative care needs of the population is necessary. The expansion of the support network for chronic and non-t...

Journal of Palliative Care & Medicine, 2017

Background: The Brazilian Health System (SUS) faces major challenges to ensure the constitutional right of universal access to health care assistance and technological advances to the entire population. Concerns with the ageing population, the increasing incidence of cancer and the emergence of chronic non-communicable diseases include palliative care as one of the objectives of the Brazilian Health System (SUS). However, considering that each disease and individual present different social and cultural factors, needs, pattern of disease progression, associated co-morbidities and access to health care, the estimation of necessary resources and the definition of specific criteria to structure and adapt palliative care in the health services have been a difficult task in Brazil. Thus, it is necessary to estimate the needs and the resources and to specify parameters to structure and tailor an adequate modality of assistance in palliative care. Aims: 1) To estimate the number of cancer patients with palliative care needs in the population; 2) To simulate palliative care methods for population based estimation. Methods: The present methodology has a quantitative approach, with descriptive, exploratory, retrospective and observational studies of hospitalized cancer patients. This is a cross-sectional study using death certificate and hospital admission data, which was collected from the Mortality Information System (SIM) and Hospital Information System (SIH) of the Brazilian Health System (SUS), obtained from the database of the Health Information Department (DATASUS). Results: Yearly around 1.1 million deaths were reported to the Brazilian Mortality Information System, being 15.9% of these related to people living with cancer. Between 2008 and 2014, there were almost 4.5 million hospitalizations (4,431,685) of patients with cancer in Brazil, and, of all the hospital admissions of cancer patients, 1.189.908 (26.85%) were related to intercurrences of the disease and/or of treatment. The average rate of hospital mortality was 7.7 for cancer in general and 21.4 for clinical intercurrence of cancer patients, while the average length of stay (LOS) was 5.7 days for cancer in general and 7.9 days for clinical intercurrence of cancer patients. Conclusion: considering that the offer and the technical guidance regarding palliative care for users served by health establishments authorized by Brazilian Health System for the specialized assistance in oncology are mandatory, we need to estimate the needs, resources and specify parameters to structure and tailor an adequate modality of assistance in palliative care.

Cadernos de Saúde Pública

In 2022, an important international report was published on the “value of death” not only in the field of health, but in relation to human societies in general. This report proposed to reimagine systems related to end of life in which death is understood not only as a physiological event but also as a relational and spiritual phenomenon with a value of its own and inseparable from life. It identifies the low priority given by most governments worldwide to the issue of alleviating suffering and supporting bereavement, evidenced by the low investment in palliative care. At the same time, we are witnessing in Brazil changes that threaten the feasibility of palliative care policies in primary health care. The denial of finitude within health systems is reflected in global indicators such as the quality of death index of The Economist magazine, in which Brazil ranks 42nd, the global atlas of palliative care of the World Hospice and Palliative Care Alliance, where Brazil is in level 3b, a...

It has been a difficult task to define the number of patients in need of palliative care, the necessary resources and the specific criteria to structure and adapt palliative care services in Brazil. Until now the quantification of palliative care needs in our country has been estimated in an isolated way and based on international experiences. However, there are doubts about the applicability of these parameters considering the population and territorial dimensions, as well as the regional diversities. The analysis of the population morbidity and mortality profiles is necessary to the establishment of possible parameters to be employed for the assistance in palliative care, such as hospital admissions for the treatment of clinical intercurrences of cancer patients. Aims: To develop estimates of the current situation, the coverage and the need for palliative care services. Identify the number of hospitals that admitted potential patients with palliative care needs and the number of hospital beds used for the hospitalizations. Methods: Retrospective and observation analysis of the hospital admission registers of cancer patients were performed to verify the number of cancer patients in need of palliative care and the number of clinic hospital beds used yearly to admit these patients. Data on hospital admission of cancer patients, like average length of stay and hospital mortality were used. Results: Between 2008 and 2016, were registered in the Hospital Information System of SUS (SIH-SUS) 1,7 million hospitalizations for treatment of clinical intercurrence of cancer patient. These admissions were identified on 3,374 different health units around the country. An average of 91% of all hospitalizations for treatment of clinical intercurrence of cancer patient were registered in 380 hospitals Conclusions: To improve the quality of life, relieve physical suffering, cater for the psychological, spiritual and social needs of people with severe and advanced diseases, as well as to provide support to families and caregivers, it is indispensable to consider the existing models of health care. The inclusion or expansion of palliative attention meets the size, nature and severity of the needs of cancer patients.

Journal of Palliative Care & Medicine, 2016

Background: Cancer figures among the leading causes of morbidity and mortality in Brazil, with approximately 576,000 new cases and around 200,000 cancer-related deaths in 2013. According to the Brazilian National Oncological Policy, cancer control must include health promotion, prevention, diagnosis, treatment, rehabilitation, and palliative care, following the Brazilian Health System (SUS) guiding principles of Universality, Equity, and Integrality of health care. Aims: 1) Outline the hospital admissions of patients for the treatment of clinical cancer intercurrences in the Brazilian Health System (SUS) between 2008-2013; 2) Estimate the number of cancer patients with palliative care needs. Methods: Quantitative methods were employed, through the analysis of descriptive, exploratory, retrospective, and observational studies of hospitalized cancer patients. Data was collected from the Hospital Information System of Brazilian Health System (SIH/SUS) in the database of the Health Information Department (DATASUS). Results: Between 2008 and 2013, there were almost 4 million hospitalizations (3,701,409) of patients with cancer in Brazil. Of all the hospital admissions of cancer patients, 978,322 (26.4%) were related to clinical intercurrences (complications) of the disease and/or for treatment. In the same period, approximately 7 million deaths were reported to the Brazilian Mortality Information System (SIM), 15.9% (1,091,837) of cancer. The average rate of hospital mortality of clinical cancer intercurrences was three times (21.4%) higher than the mortality of patients admitted for treatment of clinical cancer in general (7.7%). The hospital length of stay (LOS) of general cancer patients was 5.7 days against 7.9 days of clinical cancer intercurrence patients. It was verified that approximately 90% of those admissions registered in the procedure "Treatment of Clinical Intercurrences of Cancer Patient" in Brazil were related to palliative care of terminally ill patients. Conclusion: The analysis of the morbidity and mortality profile of cancer patients suggests that palliative care services should be considered as criteria for the treatment of clinical cancer intercurrences. Further study of the hospital procedure "Treatment of clinical complications of cancer patient" should be considered as a parameter for scaling palliative care services in Brazil.

Revista Bioética

Palliative care is a multidisciplinary health care model that seeks to provide comfort to patients with life-threatening or severe and terminal illness. Palliative medicine has only recently been recognized in Brazil, and it is essential that physicians working in this area develop their knowledge. Thus, to improve training models in palliative care and in medical education in Brazil, we must understand the characteristics of this professional, identifying sociodemographic profile, professional training, and work activity. This is a cross-sectional, descriptive, and exploratory study, with a quantitative approach. Data were collected from a national survey conducted by means of questionnaires applied to palliative care physicians in Brazil.

methaodos.revista de ciencias sociales, 2017

espanolDefinir el numero de pacientes que necesitan cuidados paliativos, los recursos necesarios y los criterios especificos para estructurar y adaptar los servicios de cuidados paliativos en Brasil ha sido una tarea dificil. Hasta el momento, la cuantificacion de las necesidades de cuidados paliativos en nuestro pais ha sido estimada de un modo aislado y se ha basado en experiencias internacionales. Sin embargo, hay dudas sobre la aplicabilidad de esos parametros considerando la poblacion y las dimensiones territoriales, tan bien como las diversidades regionales. El analisis de los perfiles de morbilidad y mortalidad de la poblacion es necesario para el establecimiento de los posibles parametros para ser empleados en la asistencia a cuidados paliativos, como las admisiones hospitalarias para el tratamiento de las patologias clinicas asociadas a los pacientes de cancer. Objetivos: Desarrollar una estimacion de la situacion, la cobertura y las necesidades actuales de servicios de cui...

Hospital: o local com maior ocorrência de óbitos de idosos no Brasil – o início de um debate Currently, in Brazil, life expectancy at birth is 71.9 years for men and 79.1 years for women, a considerable increase in relation to the 64.0 and 71.6 years calculated, respectively, for men and women born in 1993. 1 Therefore, the report Marcucci and collaborators presented in this edition of Geriatrics, Gerontology and Aging on the increase in the proportion of deaths at 60 years of age or over in a decade — from 57 to 63% of all occurrences — is not surprising. The article is not limited to this observation, and mentions, with considerable appropriateness, an important discussion about the dying process among elderly people in Brazil. With the advent of hospitals and specialized care units, such as intensive care units (ICUs), people in critical condition are referred to these units for treatment (cure, if possible), or remediation/stabiliza-tion of their health condition — even in terminal cases that are doomed to failure due to lack of perspective of survival. In Brazil, there are no or very few structures that provide health care for people — elderly or not — at the end of life, such as home care initiatives, palliative care, hospices, or nursing homes. The scenario described above, at least in part, justifies the authors' remarkable observation that the majority of deaths among elderly populations occur in hospitals (≈67%) and not at home (≈21%). In fact, between 2002 and 2013, there was an increase of 25% of hospital deaths in the general population , and 45% for those over 60 years of age. This occurred despite studies reporting an explicit preference of people for dying at home, considering the availability of structure and support. However, Brazilian social and economic perspectives, marked by reduced family members and employment relationships extended by a new social security system (except for transformations that are not yet perceptible) should contribute to intensify and overburden this model of " institutionalized " death. This should impose great demand for the creation, expansion, and training of inpatient palliative care services, at least in the first instance. It is long past time to discuss end-of-life care in old age and humanized death in multiple areas, themes that are only modestly distributed within the health services themselves. In this context, the work of the Permanent Committee on Palliative Care of the Brazilian Society of Geriatrics and Gerontology (SBGG) is remarkable. Since its creation in 2004, SBGG and other entities develop activities throughout the country to disseminate the practice of palliative care. Discussing the process of death and dying requires maturity, a conscious examination of our trajectories and options, and a clear position in this context. Recognizing that the country adopts the hospital environment as the main place of death for elderly people, whether by choice or lack of it, is the first step to acquire this lucidity. Brazilian society owes this discussion to itself, as well as the adoption of this kind of care. CONTROVERSIES In other countries, the desire to die at home versus the reality of most of them ending life in the hospital is very similar, even in societies where palliative care and home care were better implemented than in Brazil. Even in richer countries, these two types of care are always insufficient and only accessible to a minority. This lack of implementation of efficient programs surprises us because they not only alleviate people's suffering but also, in the long run, cost less than traditional interventions, as several studies indicate. 2,3

Brazilian Journal of Anesthesiology (English Edition), 2014

Background and objectives: in Brazil, palliative care (PC) is not properly structured and that reality transforms this theme in a public health problem; therefore, initiatives become relevant in this context. This paper aims to share the experience that occurred in an oncology referral hospital in the State of Maranhão and present initiatives that helped in the development of PC Service. Experience report: the hospital had an outpatient Pain and PC Service, but without specialized beds. The terminally ill patients stayed in common wards, which caused much unrest. A sensitization process was initiated in the hospital through initiatives, such as a photo contest called Flashes of Life and a ward called Room of Dreams, designed in partnership with the architecture course at the Universidade Estadual do Maranhão. The process culminated in the granting of wards to the PC and in the commitment of the Foundation, sponsor of the hospital, to run the project. Conclusion: this experience was a reproducible local initiative for the establishment of PC in a cancer hospital. Local initiatives are valuable in Brazil because they favor a significant number of patients and show its effectiveness in practice to governments and society. To structure a PC service, it is essential to establish priorities that include the assignment of drugs for management of symptoms, humanization, multidisciplinarity, sensitization and education of professionals.

Ciência & Saúde Coletiva, 2015

An aging population and epidemiological transition involves prolonged terminal illnesses and an increased demand for end-stage support in health services, mainly in hospitals. Changes in health care and government health policies may influence the death locations, making it possible to remain at home or in an institution. The scope of this article is to analyze death locations in the city of Londrina, State of Paraná, from 1996 to 2010, and to verify the influence of population and health policy changes on these statistics. An analysis was conducted into death locations in Londrina in Mortality Information System (SIM) considering the main causes and locations of death. There was an increase of 28% in deaths among the population in general, though 48% for the population over 60 years of age. There was an increase of deaths in hospitals, which were responsible for 70% of the occurrences, though death frequencies in others locations did not increase, and deaths in the home remained at about 18%. The locations of death did not change during this period, even with health policies that broadened care in other locations, such as the patient´s home. The predominance of hospital deaths was similar to other Brazilian cities, albeit higher than in other countries.