RESUMO
Background: Patients with hematological malignancies have significant and diverse palliative care needs but are not usually referred to specialist palliative care services in a timely manner, if at all. Objective: To identify the characteristics of patients with hematological malignancies referred to the palliative care service in a tertiary hospital in Mexico City. Patients: Retrospective study including consecutive patients with hematological malignancies referred to palliative care services at Mexico's National Cancer Institute. Results: Between 2011 and 2019, 5,017 patients with hematological malignancies were evaluated for first time at Mexico's National Cancer Institute. Of these, 9.1% (n = 457) were referred to palliative care. Most were male (53.4%), with a median age of 58 years. The most frequent diagnosis was non-Hodgkin lymphoma (54.9%). The primary indication for referral to palliative care was for cases wherein chemotherapy was no longer an option (disease refractory to treatment, 42.8%). The median time of referral to the palliative care service occurred 11.2 months after the first evaluation at the National Cancer Institute and death occurred on median 1.1 months after the first palliative care evaluation. Conclusion: Patients with hematological neoplasms are infrequently referred to Palliative Care at the Institute (9.1%). We found no clear referral criteria for Palliative Care referral and note that hematologists' optimism regarding a cure can delay referrals. Clearly, we have a long way to go in improving the number of patients referred, and we still saw frequent referrals near the end of life, but the high rate of outpatient referrals is encouraging.
Assuntos
Neoplasias Hematológicas , Enfermagem de Cuidados Paliativos na Terminalidade da Vida , Neoplasias , Humanos , Masculino , Pessoa de Meia-Idade , Feminino , Cuidados Paliativos , Estudos Retrospectivos , Neoplasias Hematológicas/terapia , Encaminhamento e Consulta , Neoplasias/terapiaRESUMO
Objetivo. Identificar con técnicas de biología molecular, los de Ó-Thal en poblaciones hospitalarias seleccionadas. Métodos. Diez y ocho propositi con datos hematológicos y bioquímicos sugestivos de talasemia-Ó, seleccionados de 356 pacientes con probable hemoglobinopatía provenientes de cuatro hospitales de dos ciudades, se investigaron para seis alelos comunes de talasemia-Ó. Los estudios moleculares se realizaron por reacción en cadena de la polimerasa y digestión con enzimas de restricción específicas. Resultados. El alelo Ó se identificó en dos casos: el estudio familiar mostró el mismo alelo en la madre de ambos y se detectó además heterocigocidad para HbS en uno de ellos. El análisis con Apa I reveló en ambos pacientes la deleción clase I que es el alelo más comúnmente observado en el mundo. Este estudio mostró 2/356 (0.6 por ciento) de portadores Ó, una frecuencia baja comparada con la observada en otras poblaciones del mundo. La ausencia de los otros alelos sugiere que en México la talasemia-Ó es molecularmente tan heterogénea como la talasemia-ß