Obstinación diagnóstica en pacientes oncológicos hospitalizados en situación de últimos días

Abstract

Introduction: Any limitation of therapeutic effort should include a limitation of diagnostic tests not contributing to patient comfort. The aim of the present study was to assess the use of diagnostic tests among hospitalized cancer patients during their last days of life. Methods: A retrospective observational study was performed on all stage-IV cancer patients who died during hospitalization in the Internal Medicine Unit over a period of two years. Analyzed variables included: age, gender, number of laboratory tests, and number of imaging tests (plain X-rays, ultrasound, computed tomography [CT], magnetic resonance imaging [MRI]), and whether a blood test had been performed within the last 48 hours of life. Results: A total of 51 patients were included (women, 15; 29.4 %) with an average age of 71.94 years (standard deviation, 11.06). Of these, 45 patients (88.4 %) underwent laboratory tests with a median of 3 tests per patient (interquartile range, 1.5), 41 patients (80.4 %) underwent imaging tests with a median of 1 test per patient (interquartile range, 1.3). The frequencies of imaging tests were: plain X-rays, 37 patients (72.5 %); ultrasounds, 17 patients (33.3 %); CT, 12 patients (23.6 %); MRI, 1 patient (2 %). Twenty-three patients (45.1 %) underwent at least one blood test within their last 48 hours of life. Conclusions: A large number of laboratory and imaging tests are performed during the last days of terminally ill, hospitalized cancer patients. While these tests are not considered to be invasive, they cause unnecessary discomfort to patients, and do not contribute to symptom relief.