Cuidados paliativos no tratamento de cães com câncer: o estado da arte de prevenir e aliviar a dor e o sofrimento do paciente, e oferecer assistência e apoio integral a relação humano-animal
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Data
2022-03-04
Autores
Paz, Beatriz Furlan
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Universidade Estadual Paulista (Unesp)
Resumo
Os cuidados paliativos envolvem terapias que visam a melhora da qualidade de vida e alívio do sofrimento físico, emocional e social de animais com doenças crônicas, degenerativas, ou que ameacem sua vida. Além do aspecto multidimensional do cuidado para o animal, visa o bem-estar e alívio do sofrimento emocional, social e espiritual vivenciados por seu tutor. Busca-se com esta pesquisa promover o controle de sintomas e a melhora da qualidade de vida de cães com câncer durante o atendimento de cuidados paliativos, ofertado no Hospital Veterinário “Governador Laudo Natel” (HV). Setenta e três animais formaram o grupo de atendimento (Grupo A), composto por cães que receberam cuidados paliativos. Enquanto, o grupo controle (Grupo C), foi formado por 45 animais sem acesso a esta terapia. Todos os tutores responderam o formulário “Escala de Avaliação de Sintomas Modificada”, que avaliou até quatorze sintomas apresentados pelo animal nos últimos sete dias. O instrumento mensurou a intensidade, frequência e angústias geradas pelo sintoma ao animal e seu cuidador. Ao final do período de atendimento, os tutores de pacientes do grupo A atribuíram uma nota de zero a dez de acordo com a qualidade de vida de seus animais, sendo dez referente a qualidade de vida que não poderia ser melhor e zero que não poderia ser pior. Os animais eleitos para o grupo A receberam cuidados paliativos mediante encaminhamento veterinário (46,6%), solicitação do tutor (17,8%), convite da equipe de pesquisa (27%), ou outros (8,2%). Os participantes do grupo controle foram associados a animais que realizaram cirurgias com intenção curativa, iniciaram o primeiro atendimento para avaliação e tratamento do câncer no HV, desse modo apresentaram maior sobrevida e menor pontuação de sintomas durante três momentos distintos de avaliação. Pacientes que receberam cuidados paliativos vivenciaram maior número de sintomas, com maior frequência de anorexia (45,4% versus 14,9%, p < 0,001), dor (42,53% versus 18,54%, p < 0,001), falta de energia (42,53% versus 17,22%, p < 0,001) entre outros. Neste grupo foi observada maior frequência de metástases (40,3% versus 11,11%, p < 0,001), e taxa de óbito (73,9% x 22,3%, p < 0,001). Pacientes que foram encaminhados para cuidados paliativos foram associados a não receberem tratamentos contra o câncer, e procedimentos cirúrgicos. A partir da oferta de cuidados paliativos foi observada melhor qualidade de vida comparativamente ao período sem este tratamento, sendo atribuída nota mediana e IIR 8 (6-8) para o período com atendimento conjunto de cuidados paliativos, e 6 (4-8) ao receberem atendimento exclusivo para combate ao câncer. Receber tratamentos contra o câncer, como quimioterapia adjuvante, reduziu o risco de óbito (HR: 0,22; IC: 0,08 – 0,59; p < 0,01), sendo necessária a compreensão de que os cuidados paliativos são indicados e beneficiam pacientes com câncer em conjunto com outras técnicas para controle da doença. Portanto, o emprego de cuidados paliativos para pacientes veterinários com câncer melhorou a gravidade de sintomas e qualidade de vida destes animais.
Palliative care involves therapies aimed at improving the quality of life and relieving the physical, emotional and social suffering of animals with chronic, degenerative, or life-threatening diseases. In addition to the multidimensional aspect of care for the animal, it aims at the well-being and relief of the emotional, social and spiritual suffering experienced by its owner. The aim of this research is to promote the control of symptoms and the improvement of the quality of life of dogs with cancer during palliative care, offered at the Veterinary Hospital “Governador Laudo Natel”. Seventy-three animals formed the care group (Group A), composed of dogs that received palliative care. Meanwhile, the control group (Group C) was formed by 45 animals without access to this therapy. All tutors answered the “Modified Symptom Assessment Scale” form, which evaluated up to fourteen symptoms presented by the animal in the last seven days. The instrument measured the intensity, frequency and distress generated by the symptom to the animal and its caregiver. At the end of the period of care, the tutors of patients in group A assigned a score from zero to ten according to the quality of life of their animals, with ten referring to the quality of life that could not be better and zero that it could not be better. worst. Patients who received palliative care had a greater burden of symptoms, with a higher frequency of anorexia (45.4% versus 14.9%, p < 0.001), pain (42.53% versus 18.54%, p < 0.001), lack of energy (42.53% versus 17.22%, p < 0.001) among others. In this group, there was also a higher frequency of metastases (40.3% versus 11.11%, p < 0.001), and a death rate (73.9% versus 22.3%, p < 0.001). In view of this situation, it was observed that patients who received palliative care had a better quality of life compared to the period without this treatment, with a median and IIR score of 8 (6-8) for the period with joint palliative care, and 6 (4-8) when receiving exclusive care to fight cancer. When palliative care was started early, right after the animal's first consultation or at the time of cancer diagnosis, a better evolution of symptoms was observed than those animals that started treatment late. Therefore, the use of palliative care for veterinary cancer patients has improved the symptom burden and quality of life of these animals.
Palliative care involves therapies aimed at improving the quality of life and relieving the physical, emotional and social suffering of animals with chronic, degenerative, or life-threatening diseases. In addition to the multidimensional aspect of care for the animal, it aims at the well-being and relief of the emotional, social and spiritual suffering experienced by its owner. The aim of this research is to promote the control of symptoms and the improvement of the quality of life of dogs with cancer during palliative care, offered at the Veterinary Hospital “Governador Laudo Natel”. Seventy-three animals formed the care group (Group A), composed of dogs that received palliative care. Meanwhile, the control group (Group C) was formed by 45 animals without access to this therapy. All tutors answered the “Modified Symptom Assessment Scale” form, which evaluated up to fourteen symptoms presented by the animal in the last seven days. The instrument measured the intensity, frequency and distress generated by the symptom to the animal and its caregiver. At the end of the period of care, the tutors of patients in group A assigned a score from zero to ten according to the quality of life of their animals, with ten referring to the quality of life that could not be better and zero that it could not be better. worst. Patients who received palliative care had a greater burden of symptoms, with a higher frequency of anorexia (45.4% versus 14.9%, p < 0.001), pain (42.53% versus 18.54%, p < 0.001), lack of energy (42.53% versus 17.22%, p < 0.001) among others. In this group, there was also a higher frequency of metastases (40.3% versus 11.11%, p < 0.001), and a death rate (73.9% versus 22.3%, p < 0.001). In view of this situation, it was observed that patients who received palliative care had a better quality of life compared to the period without this treatment, with a median and IIR score of 8 (6-8) for the period with joint palliative care, and 6 (4-8) when receiving exclusive care to fight cancer. When palliative care was started early, right after the animal's first consultation or at the time of cancer diagnosis, a better evolution of symptoms was observed than those animals that started treatment late. Therefore, the use of palliative care for veterinary cancer patients has improved the symptom burden and quality of life of these animals.
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Palavras-chave
Animais, Assistência terminal, Oncologia