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Indications and use of palliative surgery-results of society of surgical oncology survey

Annals of Surgical Oncology volume 9, pages 104–112 (2002)Cite this article

Abstract

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.

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References

  1. Greenlee RT, Hill-Harmon MB, Murray T, et al. Cancer Statistics 2001.CA Cancer J Clin 2001;51:15–36.

    Article  PubMed  CAS  Google Scholar 

  2. Field MJ, Cassell CK.Approaching Death-Improving Care at the End of Life. Washington, D.C., National Academy Press 1997.

    Google Scholar 

  3. Halstead WJ. The results of radical operations for the cure of cancer of the breast.Ann Surg 1907;46:1–27.

    Article  Google Scholar 

  4. Miner TJ, Jaques DP, Shriver C. Decision making on surgical palliation based on patient outcome data.A J Surg 1999;177:150–54.

    Article  CAS  Google Scholar 

  5. 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.

    PubMed  CAS  Google Scholar 

  6. 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.

    Article  PubMed  CAS  Google Scholar 

  7. Boddie AW, Jr, McMurtrey MJ, Giacco GG, et al. Palliative total gastrectomy and esophagogastrectomy. A reevaluation.Cancer 1983;51:1195–200.

    Article  PubMed  Google Scholar 

  8. 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.

    Article  PubMed  CAS  Google Scholar 

  9. Makela J, Haukipuro K, Laitinen S, et al. Palliative operations for colorectal cancer.Dis Colon Rectum 1990;33:846–50.

    Article  PubMed  CAS  Google Scholar 

  10. 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.

    Article  PubMed  CAS  Google Scholar 

  11. 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.

    Article  PubMed  CAS  Google Scholar 

  12. Temple WJ, Ketcham AS. Surgical palliation for recurrent rectal cancers ulcerating in the perineum.Cancer 1990;65:1111–4.

    Article  PubMed  CAS  Google Scholar 

  13. 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.

    Article  PubMed  CAS  Google Scholar 

  14. Krouse RK, Nelson RA, Ferrell BR, et al. Surgical Palliation at a Cancer Center: Incidence and Outcomes.Arch Surg 2001;136:773–8.

    Article  PubMed  CAS  Google Scholar 

  15. 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 

  16. 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.

    Article  PubMed  CAS  Google Scholar 

  17. Porter GA, Skibber JM. Outcomes research in surgical oncology.Ann Surg Oncol 2000;7:367–75.

    Article  PubMed  CAS  Google Scholar 

  18. 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.

    Article  PubMed  CAS  Google Scholar 

  19. 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.

    Article  PubMed  CAS  Google Scholar 

  20. 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.

    Article  PubMed  CAS  Google Scholar 

  21. 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.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. From the Department of General Oncologic Surgery, City of Hope National Medical Center, Duarte, California

    Laurence E. McCahill MD, David Chu MD & Lawrence D. Wagman MD

  2. Department of Nursing Research, City of Hope National Medical Center, Duarte, California

    Gloria Juarez RN, MSN & Betty Ferrell RN, PhD

  3. Department of Surgery, Southern Arizona Veteran’s Affairs Health Care System, Tucson, Arizona

    Robert Krouse MD

  4. Vital Research, Los Angeles, California

    Gwen C. Uman RN, PhD

Authors
  1. Laurence E. McCahill MD
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  2. Robert Krouse MD
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  3. David Chu MD
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  4. Gloria Juarez RN, MSN
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  5. Gwen C. Uman RN, PhD
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  6. Betty Ferrell RN, PhD
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  7. Lawrence D. Wagman MD
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Correspondence to Laurence E. McCahill MD.

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McCahill, L.E., Krouse, R., Chu, D. et al. Indications and use of palliative surgery-results of society of surgical oncology survey. Ann Surg Oncol 9, 104–112 (2002). https://doi.org/10.1245/aso.2002.9.1.104

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  • DOI: https://doi.org/10.1245/aso.2002.9.1.104

Keywords

  • Palliative Care
  • Gastric Outlet Obstruction
  • Palliative Care Specialist
  • Recurrent Rectal Cancer
  • Metastatic Spinal Cord Compression