Skip to main content

Advertisement

SpringerLink
Log in

Increased in-hospital mortality and emergent cases in patients with stage IV cancer

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Background

Cancer patients in the USA are still being treated with aggressive, life-prolonging interventions. Palliative care services remain vastly underutilized despite surges in both quality and quantity of programs. We evaluated surgical outcomes of metastatic cancer patients to question whether palliative care may be a better option.

Study design

We queried the 2014 National Surgical Quality Improvement Program database (NSQIP) for patients with a diagnosis of malignancy (ICD 9 Codes 145.00 to 200.00). Cases were divided into metastatic and non-metastatic cancer. Demographic data including preoperative, intraoperative, and postoperative factors, as well as complications and comorbidities were compared between these two groups. Independent t testing was used to compare continuous variables. Chi-square testing was used to compare categorical variables. Multiple logistic regression was used to assess for predictors of mortality in metastatic cancer.

Results

A total of 80,275 cancer patients were analyzed, 11.8% (9423) of whom had metastatic disease. In-hospital mortality rate was found to be 4 times higher among patients with metastatic cancer (2.1% vs. 0.5%; P = < 0.0001). Of those metastatic cancer patients that died while in hospital, 18.5% had an emergency surgery performed. After adjusting for confounders, dyspnea at rest/moderate exertion (OR 5.7/2.4; 95% CI 2.7/1.6 to 11.9/3.7; P < 0.0001) was found to be the most significant predictor of in hospital mortality in stage IV cancer patients.

Conclusion

Aggressive treatment in advanced cancer patients contributes to alarmingly high in-hospital mortality. Improved, deliberate communication of palliative care options with patients is exceedingly conducive to enhancing end-of-life cancer care.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data availability

The 2014 National Surgical Quality Improvement Program database (NSQIP) was queried to obtain data for this manuscript.

References

  1. Bilimoria KY, Liu Y, Paruch JL, Zhou L, Kmiecik TE, Ko CY, Cohen ME (2013) Development and evaluation of the universal ACS NSQIP surgical risk calculator: a decision aid and informed consent tool for patients and surgeons. J Am Coll Surg 217:833–842.e833

    Article  Google Scholar 

  2. Birkmeyer JD, Hamby LS, Birkmeyer CM, Decker MV, Karon NM, Dow RW (2001) Is unplanned return to the operating room a useful quality indicator in general surgery? Arch Surg 136:405–411

    Article  CAS  Google Scholar 

  3. Cheng L, DeJesus AY, Rodriguez MA (2017) Using laboratory test results at hospital admission to predict short-term survival in critically ill patients with metastatic or advanced cancer. J Pain Symptom Manag 53:720–727

    Article  Google Scholar 

  4. Danai PA, Moss M, Mannino DM, Martin GS (2006) The epidemiology of sepsis in patients with malignancy. Chest 129:1432–1440

    Article  Google Scholar 

  5. Duggan KT, Hildebrand Duffus S, D'Agostino RB, Petty WJ, Streer NP, Stephenson RC (2017) The impact of hospice services in the care of patients with advanced stage nonsmall cell lung cancer. J Palliat Med 20:29–34

    Article  Google Scholar 

  6. Earle CC, Neville BA, Landrum MB, Ayanian JZ, Block SD, Weeks JC (2004) Trends in the aggressiveness of cancer care near the end of life. J Clin Oncol 22:315–321

    Article  Google Scholar 

  7. Earle CC, Landrum MB, Souza JM, Neville BA, Weeks JC, Ayanian JZ (2008) Aggressiveness of cancer care near the end of life: is it a quality-of-care issue? J Clin Oncol 26:3860–3866

    Article  Google Scholar 

  8. Everett B, Zajacova A (2015) Gender differences in hypertension and hypertension awareness among young adults. Biodemography Soc Biol 61:1–17

    Article  Google Scholar 

  9. Ferrell BR, Temel JS, Temin S, Alesi ER, Balboni TA, Basch EM, Firn JI, Paice JA, Peppercorn JM, Phillips T, Stovall EL, Zimmermann C, Smith TJ (2017) Integration of palliative care into standard oncology care: american society of clinical oncology clinical practice guideline update. J Clin Oncol 35:96–112

    Article  Google Scholar 

  10. Fine PG (2018) Hospice underutilization in the U.S.: the misalignment of regulatory policy and clinical reality. J Pain Symptom Manag 56:808–815

    Article  Google Scholar 

  11. Fine PG, Davis MS (2017) Lessons from the hospice benefit for advanced illness care generations. Journal of the American Society on Aging 41:58–67

    Google Scholar 

  12. Glare P, Virik K, Jones M, Hudson M, Eychmuller S, Simes J, Christakis N (2003) A systematic review of physicians’ survival predictions in terminally ill cancer patients. Br Med J 327:195–198

  13. Gomes B, Calanzani N, Koffman J, Higginson IJ (2015) Is dying in hospital better than home in incurable cancer and what factors influence this? A population-based study. BMC Med 13:235–235

    Article  Google Scholar 

  14. Greer JA, Pirl WF, Jackson VA, Muzikansky A, Lennes IT, Heist RS, Gallagher ER, Temel JS (2012) Effect of early palliative care on chemotherapy use and end-of-life care in patients with metastatic non–small-cell lung cancer. J Clin Oncol 30:394–400

    Article  Google Scholar 

  15. Hutcheson A (2011) Hospice care in the United States. Prim Care 38:173–182 vii

    Article  Google Scholar 

  16. Kamboj M, Sepkowitz KA (2009) Nosocomial infections in patients with cancer. Lancet Oncol 10:589–597

    Article  Google Scholar 

  17. Kao YH, Chiang JK (2015) Effect of hospice care on quality indicators of end-of-life care among patients with liver cancer: a national longitudinal population-based study in Taiwan 2000-2011. BMC Palliat Care 14:39

    Article  Google Scholar 

  18. Matsuyama R, Reddy S, Smith TJ (2006) Why do patients choose chemotherapy near the end of life? A review of the perspective of those facing death from cancer. J Clin Oncol 24:3490–3496

    Article  Google Scholar 

  19. Philip J, Hudson P, Bostanci A, Street A, Horey DE, Aranda S, Zordan R, Rumbold BD, Moore G, Sundararajan V (2015) Metastatic non-small cell lung cancer: a benchmark for quality end-of-life cancer care? Med J Aust 202:139–143

    Article  Google Scholar 

  20. Ripamonti C (1999) Management of dyspnea in advanced cancer patients. Support Care Cancer 7:233–243

    Article  CAS  Google Scholar 

  21. Saito AM, Landrum MB, Neville BA, Ayanian JZ, Earle CC (2011) The effect on survival of continuing chemotherapy to near death. BMC Palliative Care 10:14

    Article  Google Scholar 

  22. Smith AK, McCarthy E, Weber E, Cenzer IS, Boscardin J, Fisher J, Covinsky K (2012) Half of older Americans seen in emergency department in last month of life; most admitted to hospital, and many die there. Health Aff 31:1277–1285

    Article  Google Scholar 

  23. Tang ST (2003) When death is imminent: where terminally ill patients with cancer prefer to die and why. Cancer Nurs 26.3: 245–251

  24. Teno JM, Casarett D, Spence C, Connor S (2012) It is “too late” or is it? Bereaved family member perceptions of hospice referral when their family member was on hospice for seven days or less. J Pain Symptom Manag 43:732–738

    Article  Google Scholar 

  25. Torres VB, Azevedo LC, Silva UV, Caruso P, Torelly AP, Silva E, Carvalho FB, Vianna A, Souza PC, Godoy MM, Azevedo JR, Spector N, Bozza FA, Salluh JI, Soares M (2015) Sepsis-associated outcomes in critically ill patients with malignancies. Ann Am Thorac Soc 12:1185–1192

    PubMed  Google Scholar 

  26. Triplett DP, LeBrett WG, Bryant AK, Bruggeman AR, Matsuno RK, Hwang L, Boero IJ, Roeland EJ, Yeung HN, Murphy JD (2017) Effect of palliative care on aggressiveness of end-of-life care among patients with advanced cancer. J Oncol Pract 13:e760–e769

    Article  Google Scholar 

  27. Wang X, Knight LS, Evans A, Wang J, Smith TJ (2017) Variations among physicians in hospice referrals of patients with advanced cancer. J Oncol Pract 13:e496–e504

    Article  Google Scholar 

  28. Yoo SH, Keam B, Kim M, Kim TM, Kim D-W, Heo DS (2018) The effect of hospice consultation on aggressive treatment of lung cancer. Cancer Res Treat 50:720–728

    Article  Google Scholar 

  29. Yucel N, Sukru Erkal H, Sinem Akgun F, Serin M (2012) Characteristics of the admissions of cancer patients to emergency department. J buon 17:174–179

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA

    Elleana J. Majdinasab

  2. Department of Surgery, West Virgina University School of Medicine, 3200 MacCorkle Ave SE,, Charleston, WV, 25304, USA

    Yana Puckett

  3. Department of Acute Care Surgery and Surgical Critical Care, Houston Methodist, Houston, TX, USA

    Kevin Y. Pei

Authors
  1. Elleana J. Majdinasab
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yana Puckett
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kevin Y. Pei
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Yana Puckett, MD, MBA, MPH, MSc, Kevin Pei, MD, FACS, MHSEd, and Elleana Joy Majdinasab. The first draft of the manuscript was written by Elleana Joy Majdinasab, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Yana Puckett.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

This retrospective chart review was granted exemption from IRB approval.

Consent to participate

Exemption was granted.

Consent for publication

Exemption was granted.

Code availability

Not applicable.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Majdinasab, E.J., Puckett, Y. & Pei, K.Y. Increased in-hospital mortality and emergent cases in patients with stage IV cancer. Support Care Cancer 29, 3201–3207 (2021). https://doi.org/10.1007/s00520-020-05837-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-020-05837-8

Keywords

Search

Navigation