Background: Despite increasing attention to end-of-life care in oncology, palliative surgery (PS) remains poorly defined. A survey to test the definition, assess the extent of use, and evaluate attitudes and goals of surgeons regarding PS was devised.
Methods: A survey of Society of Surgical Oncology (SSO) members.
Results: 419 SSO members completed a 110-item survey. Surgeons estimated 21% of their cancer surgeries as palliative in nature. Forty-three percent of respondents felt PS was best defined based on pre-operative intent, 27% based on post-operative factors, and 30% on patient prognosis. Only 43% considered estimated patient survival time an important factor in defining PS, and 22% considered 5-year survival rate important. The vast majority (95%) considered tumor still evident following surgery in a patient with poor prognosis constituted PS. Most surgeons felt PS could be procedures due to generalized illness related to cancer (80%) or related to cancer treatment complications (76%). Patient symptom relief and pain relief were identified as the two most important goals in PS, with increased survival the least important.
Conclusion: PS is a major portion of surgical oncology practice. Quality-of-life parameters, not patient survival, were identified as the most important goals of PS.
Palliative Care Gastric Outlet Obstruction Palliative Care Specialist Recurrent Rectal Cancer Metastatic Spinal Cord Compression
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Field MJ, Cassell CK.Approaching Death-Improving Care at the End of Life. Washington, D.C., National Academy Press 1997.Google Scholar
Halstead WJ. The results of radical operations for the cure of cancer of the breast.Ann Surg 1907;46:1–27.CrossRefGoogle Scholar
Miner TJ, Jaques DP, Shriver C. Decision making on surgical palliation based on patient outcome data.A J Surg 1999;177:150–54.CrossRefGoogle Scholar
Turner S, Marosszeky B, Timms I, et al. Malignant spinal cord compression: a prospective evaluation.Int J Radiat Oncol Biol Phys 1993;26:141–6.PubMedGoogle Scholar
Maranzano E, Latini P, Checcaglini F, et al. Radiation therapy in metastatic spinal cord compression. A prospective analysis of 105 consecutive patients.Cancer 1991;67:1311–7.PubMedCrossRefGoogle Scholar
Boddie AW, Jr, McMurtrey MJ, Giacco GG, et al. Palliative total gastrectomy and esophagogastrectomy. A reevaluation.Cancer 1983;51:1195–200.PubMedCrossRefGoogle Scholar
Branicki FJ, Law SY, Fok M, et al. Quality of life in patients with cancer of the esophagus and gastric cardia: a case for palliative resection.Arch Surg 1998;133:316–22.PubMedCrossRefGoogle Scholar
Makela J, Haukipuro K, Laitinen S, et al. Palliative operations for colorectal cancer.Dis Colon Rectum 1990;33:846–50.PubMedCrossRefGoogle Scholar
Faneyte IF, Rutgers EJ, Zoetmulder FA. Chest wall resection in the treatment of locally recurrent breast carcinoma: indications and outcome for 44 patients.Cancer 1997;80:886–91.PubMedCrossRefGoogle Scholar
Lillemoe KD, Cameron JL, Hardacre JM, et al. Is prophylactic gastrojejunostomy indicated for unresectable periampullary cancer? A prospective randomized trial.Ann Surg 1999;230:322–8; discussion 328–30.PubMedCrossRefGoogle Scholar
Temple WJ, Ketcham AS. Surgical palliation for recurrent rectal cancers ulcerating in the perineum.Cancer 1990;65:1111–4.PubMedCrossRefGoogle Scholar
Rosen SA, Buell JF, Yoshida A, et al. Initial presentation with stage IV colorectal cancer: how aggressive should we be?Arch Surg 2000;135:530–4; discussion 534–5.PubMedCrossRefGoogle Scholar
Krouse RK, Nelson RA, Ferrell BR, et al. Surgical Palliation at a Cancer Center: Incidence and Outcomes.Arch Surg 2001;136:773–8.PubMedCrossRefGoogle Scholar
Ball ABS, Baum M, Breach NM, et al. Surgical palliation. In: Doyle D, Hanks GWC, MacDonald N, eds.Oxford Textbook of Palliative Medicine (2nd ed). Oxford, Oxford University Press 1998:282–99.Google Scholar
Christakis NA, Lamont EB. Extent and determinants of error in doctors’ prognoses in terminally ill patients: Prospective cohort study.British Medical Journal 2000;320:469–72.PubMedCrossRefGoogle Scholar
Tsao JI, Nimura Y, Kamiya J, et al. Management of hilar cholangiocarcinoma: comparison of an American and a Japanese experience.Ann Surg 2000;232:166–74.PubMedCrossRefGoogle Scholar
Liu SK, Church JM, Lavery IC, et al. Operation in patients with incurable colon cancer-is it worthwhile?Dis Colon Rectum 1997;40:11–14.PubMedCrossRefGoogle Scholar
Windham TC, Pearson AS, Skibber JM, et al. Significance and management of local recurrences and limited metastatic disease in the abdomen.Surg Clin North Am 2000;80:761–74.PubMedCrossRefGoogle Scholar
Porzsolt F, Wirth A, Mayer-Steinacker R, et al. Quality assurance by specification and achievement of goals in palliative cancer treatment.Cancer Treat Rev 1996;22 Suppl A:41–9.PubMedCrossRefGoogle Scholar