LUCIANA MARTINS ROZMAN
Projetos de Pesquisa
Unidades Organizacionais
LIM/38 - Laboratório de Epidemiologia e Imunobiologia, Hospital das Clínicas, Faculdade de Medicina
3 resultados
Resultados de Busca
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- Palliative cancer care: costs in a Brazilian quaternary hospital(2022) ROZMAN, Luciana Martins; CAMPOLINA, Alessandro Goncalves; LOPEZ, Rossana Mendoza; CHIBA, Toshio; SOAREZ, Patricia Coelho DePalliative care (PC) improves the quality of life of patients with diseases such as cancer, and several studies have shown a reduction in costs among patients who use PC services when compared with those receiving standard oncological treatments. Most studies on PC costs are carried out in high-income countries. There is a lack of these types of studies in middle-income and low-income countries and of better evidence about this intervention. Objective To describe resource utilisation and costs among patients with cancer in a Brazilian quaternary hospital by cancer localisation and per month of treatment before death. Methods This study is a description of retrospective costs to estimate the costs of formal healthcare sector associated with PCs, from the perspective of a public quaternary cancer hospital. Unit costs were estimated using microcosting and macrocosting approaches. Setting/Participants Patients older than 18 years old who died from 2010 to 2013 and who had at least two visits in PC and/or made use of hospice care. Results Among the 2985 patients included in the study, the average cost per patient was US$12 335, ranging from US$8269 for patients with pancreatic cancer to US$19 395 for patients with brain cancer. The main costing item was hospital admission (47.6% of the total cost), followed by hospice care (29.5%) and medical and other supplies (11.1%). Conclusions The study clarified the direct medical costs and the profile and use of resources of patients with cancer who need PC, and can help in the planning and allocation of resources in cancer care.
- Early Palliative Care and Its Impact on End-of-Life Care for Cancer Patients in Brazil(2018) ROZMAN, Luciana Martins; CAMPOLINA, Alessandro Goncalves; LOPEZ, Rossana Veronica Mendonca; KOBAYASHI, Silvia Takanohashi; CHIBA, Toshio; SOAREZ, Patricia Coelho deBackground: Integrating palliative care into standard oncology care has been recommended for cancer patients. Early palliative care is associated with less aggressive treatment at the end of life. Objective: To describe cancer patients receiving palliative care in Brazil, determining the time from entry into palliative care to death, and investigating whether late referral to palliative care is associated with aggressive end-of-life treatment. Design: This was a cross-sectional study of cancer patients receiving palliative care in Brazil. Setting/Subjects: Subjects were 2985 cancer patients 18 years of age who received at least two palliative care visits at the SAo Paulo State Cancer Institute, in the city of SAo Paulo, Brazil, and died between 2010 and 2013. Measurements: We evaluated the time from the first palliative care consult to death, stratifying cases by the timing of entry into palliative care (3 or <3 months before death). The associations between early palliative care and indicators of aggressive treatment were assessed by Pearson's chi-square test and Fisher's exact test. Results: The overall median time between entry into palliative care and death was 34 days (mean, 72 days) and was significantly shorter in 2013 than in 2010 (p<0.001). The number of emergency department visits was significantly lower among the patients who entered palliative care earlier (p<0.001). Conclusions: Among cancer patients in Brazil, late referral to palliative care is common. Patients who enter palliative care earlier appear to receive less aggressive end-of-life treatment.
- Factors Associated with the Costs of Palliative Care: A Retrospective Cost Analysis at a University Cancer Hospital in Brazil(2021) ROZMAN, Luciana Martins; CAMPOLINA, Alessandro Goncalves; PATINO, Elizabeth Gonzalez; SOAREZ, Patricia Coelho deBackground: There have been few studies evaluating the costs of palliative care (PC) in low- and middle-income countries (LMICs), especially for patients with cancer. Objectives: The objective of this study was to identify the sociodemographic and clinical variables that could explain the cost per day of PC for cancer in Brazil. Methods: This was a retrospective cost analysis of PC at a quaternary cancer center in Sao Paulo, Brazil, between January 2010 and December 2013. Factors influencing the cost per day were assessed with generalized linear models and generalized linear-mixed models in which the random effect was the site of the cancer. Results: The study included 2985 patients. The mean total cost per patient was $12,335 (standard deviation [SD] = 14,602; 95% confidence interval [CI] = 11,803 to 12,851). The mean cost per day per patient was $325.50 (SD = 246.30, 95% CI = 316.60 to 334.30). There were statistically significant differences among cancer sites in terms of the mean cost per day. Multivariate analysis revealed that the drivers of cost per day were Karnofsky performance status, the number of hospital admissions, referral to PC, and place of death. Place of death had the greatest impact on the cost per day; death in a hospital and in hospice care increased the mean cost per day by $1.56 and $1.83, respectively. Conclusion: To allocate resources effectively, PC centers in LMICs should emphasize early enrollment of patients at PC outpatient clinics, to avoid hospital readmission, as well as advance planning of the place of death.