Abstract
Background
The purpose of this study was to determine the feasibility and optimal timing of quality of life assessment for patients undergoing palliative surgical evaluation.
Methods
Patients with an advanced malignancy undergoing consultation for palliative surgical intervention were prospectively enrolled from November 2009 to January 2011. Follow-up quality of life assessment was performed using validated instruments at 1 and 3 months post-enrollment. Univariate analysis of variables was performed to identify clinicopathologic variables associated with questionnaire completion.
Results
Of 77 patients enrolled, the most common clinical presentations included bowel obstruction (32 %), abdominal pain (21 %), wound complications (18 %), and gastrointestinal bleeding (11 %). Of the 77 patients, 34 (44 %) were treated with nonoperative/nonprocedural care, 9 (12 %) with endoscopic or interventional radiologic procedures, and 34 (44 %) with surgery. Follow-up questionnaires were obtained at 1 month and 3 months in 48 % and 15 %, respectively. A total of 31 patients (40 %) died prior to study completion. On univariate analysis, death was the only factor associated with questionnaire response. All other demographic, clinical, and treatment variables were not associated with response to questionnaires. There were no significant differences in baseline or follow-up quality of life scores between patients treated with surgical intervention or nonoperative management.
Conclusions
Death during the study period was a significant factor in limiting adequate follow-up assessment. Future studies attempting to obtain follow-up data on patients evaluated for palliative surgical intervention may require larger patient numbers to account for frequent early death in this population and anticipate the need to account for the high rate of missing data in statistical analysis.
Similar content being viewed by others
References
American Cancer Society. Cancer Facts & Figures 2011. 2011; Atlanta, GA. www.cancer.org.
Hui D, Elsayem A, De la Cruz M, Berger A, Zhukovsky DS, Palla S, et al. Availability and integration of palliative care at US cancer centers. JAMA. 2010;303:1054–61.
Bruera E, Yennurajalingam S. Palliative care in advanced cancer patients: how and when? Oncologist. 2012;17:267–73.
Badgwell BD, Smith K, Liu P, Bruera E, Curley SA, Cormier JN. Indicators of surgery and survival in oncology inpatients requiring surgical evaluation for palliation. Support Care Cancer. 2009;17:727–34.
Krouse RS, Nelson RA, Farrell BR, Grube B, Juarez G, Wagman LD. Surgical palliation at a cancer center: incidence and outcomes. Arch Surg. 2001;136:773–8.
Miner TJ, Brennan MF, Jaques DP. A prospective, symptom related, outcomes analysis of 1022 palliative procedures for advanced cancer. Ann Surg. 2004;240:719–26.
Miner TJ, Jaques DP, Tavaf-Motamen H, Shriver CD. Decision making on surgical palliation based on patient outcome data. Am J Surg. 1999;177:150–4.
Miner TJ. Palliative surgery for advanced cancer: lessons learned in patient selection and outcome assessment. Am J Clin Oncol. 2005;28:411–4.
McCahill LE, Dunn GP, Mosenthal AC, Milch RA, Krouse RS. Palliation as a core surgical principle: part 1. J Am Coll Surg. 2004;199:149–60.
McCahill LE, Smith DD, Borneman T, Juarez G, Cullinane C, Chu DZ, et al. A prospective evaluation of palliative outcomes for surgery of advanced malignancies. Ann Surg Oncol. 2003;10:654–63.
Podnos YD, Juarez G, Pameijer C, Choi K, Ferrell BR, Wagman LD. Impact of surgical palliation on quality of life in patients with advanced malignancy: results of the decisions and outcomes in palliative surgery (DOPS) trial. Ann Surg Oncol. 2007;14:922–8.
Cella DF, Tulsky DS, Gray G, Sarafian B, Linn E, Bonomi A, et al. The functional assessment of cancer therapy scale: development and validation of the general measure. J Clin Oncol. 1993;11:570–9.
Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol. 1982;5:649–55.
Badgwell BD, Cormier JN, Wray CJ, Borthakur G, Qiao W, Rolston KV, et al. Challenges in surgical management of abdominal pain in the neutropenic cancer patient. Ann Surg. 2008;248:104–9.
Miner TJ, Cohen J, Charpentier K, McPhillips J, Marvell L, Cioffi WG. The palliative triangle: improved patient selection and outcomes associated with palliative operations. Arch Surg. 2011;146:517–22.
Sutton JE, Jr. The palliative care triangle: a strategy to help make difficult surgical decisions. Arch Surg. 2011;146:522–3.
Miner TJ, Jaques DP, Shriver CD. A prospective evaluation of patients undergoing surgery for the palliation of an advanced malignancy. Ann Surg Oncol. 2002;9:696–703.
Ferrell BR, Chu DZ, Wagman L, Juarez G, Borneman T, Cullinane C, et al. Online exclusive: patient and surgeon decision making regarding surgery for advanced cancer. Oncol Nurs Forum. 2003;30:E106–14.
Schmidt C, Gerdes H, Hawkins W, Zucker E, Zhou Q, Riedel E, et al. A prospective observational study examining quality of life in patients with malignant gastric outlet obstruction. Am J Surg. 2009;198:92–9.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Badgwell, B., Krouse, R., Cormier, J. et al. Frequent and Early Death Limits Quality of Life Assessment in Patients with Advanced Malignancies Evaluated for Palliative Surgical Intervention. Ann Surg Oncol 19, 3651–3658 (2012). https://doi.org/10.1245/s10434-012-2420-5
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-012-2420-5