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Use of Palliative Interventions at End of Life for Advanced Gastrointestinal Cancer

  • Global Health Services Research
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Despite the well-established benefits of palliative care, little is known about the use of palliative interventions among patients with advanced gastrointestinal (GI) cancer near the end of life (EOL).

Methods

A national cohort study analyzed 142,304 patients with advanced GI cancers (stage 3 or 4) near EOL (death within 1 year of diagnosis) in the National Cancer Database (2004–2014) who received palliative interventions (defined as treatment to relieve symptoms: surgery, radiation, chemotherapy, and/or pain management). The study used multivariable hierarchical regression evaluate the association between the use of palliative interventions, temporal trends, and patient and hospital factors.

Results

Overall, 16.5% of the patients were treated with a palliative intervention, and use increased over time (13.4% in 2004 vs 19.8% in 2014; trend test, p < 0.001). Palliative interventions were used most frequently for esophageal cancer (20.6%) and least frequently for gallbladder cancer (13.3%). Palliative interventions were associated with younger age (odds ratio [OR], 0.99; 95% confidence interval [CI], 0.98–0.99), recent diagnosis year (OR, 1.05; 95% CI, 1.04–1.06), black race (white [ref]; OR, 1.07; 95% CI, 1.01-1.12), insurance status (no insurance [ref]; private: OR, 0.92; 95% CI ,0.95–0.99), hospital type (community cancer program [ref]; integrated network cancer programs: OR, 1.37; 95% CI ,1.07–1.75), and stage 4 disease (OR, 2.17; 95% CI, 2.07–2.27). Patients in southern and western regions were less likely to receive palliative intervention (Northeast [ref]; OR, 0.76; 95% CI, 0.62–0.94 and OR 0.46; 95% CI, 0.37–0.57, respectively).

Conclusion

Increased palliative intervention use over time suggests ongoing changes in how care is delivered to GI cancer patients toward EOL. However, sociodemographic and geographic variation suggests opportunities to address barriers to optimal EOL care.

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Acknowledgment

The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs, Baylor College of Medicine, Emory University School of Medicine, Morehouse School of Medicine, or Harvard University. The data used in this study are derived from a de-identified NCDB file. The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology employed, or the conclusions drawn from these data.

Funding

This work was supported by the Department of Veterans Affairs, the Veterans Health Administration, the Office of Research and Development, and the Center for Innovations in Quality, Effectiveness, and Safety (CIN 13-413).

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Authors and Affiliations

  1. Center for Innovations in Quality, Effectiveness, and Safety, Michael E DeBakey VA Medical Center, Houston, TX, USA

    Vivi W. Chen MD

  2. Michael E. DeBakey VA Medical Center, Department of Surgery at Baylor College of Medicine, Houston, TX, USA

    Vivi W. Chen MD & Jorge I. Portuondo MD

  3. Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA, USA

    Zara Cooper MD, MSc

  4. Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA

    Zara Cooper MD, MSc

  5. Surgical and Perioperative Service, Atlanta VA Health Care System, Decatur, GA, USA

    Nader N. Massarweh MD, MPH

  6. Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA

    Nader N. Massarweh MD, MPH

  7. Department of Surgery, Morehouse School of Medicine, Atlanta, GA, USA

    Nader N. Massarweh MD, MPH

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  1. Vivi W. Chen MD
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Correspondence to Vivi W. Chen MD.

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Chen, V.W., Portuondo, J.I., Cooper, Z. et al. Use of Palliative Interventions at End of Life for Advanced Gastrointestinal Cancer. Ann Surg Oncol 29, 7281–7292 (2022). https://doi.org/10.1245/s10434-022-12342-1

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