Indicators of symptom improvement and survival in inpatients with advanced cancer undergoing palliative surgical consultation

Brian D. Badgwell, Thomas A. Aloia, John Garrett, Gabe Chedister, Tom Miner, Robert S Krouse

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background The purpose of this study was to prospectively identify the presentation, treatment, and outcomes of inpatients with advanced malignancy undergoing palliative surgical consultation. Methods Inpatients undergoing palliative surgical consultation were prospectively identified from November 2008 to May 2011. Medical records were retrospectively reviewed to obtain clinical data and outcome. Results Of 202 consultations, the diagnoses were wound problems (N = 39, 19%), bowel obstruction (N = 75, 37%), intra-abdominal inflammatory conditions (N = 36, 18%), abdominal pain of unclear etiology (N = 13, 6%), gastrointestinal hemorrhage (N = 15, 7%), malnutrition/feeding tube request (N = 14, 7%), and biliary obstruction (N = 10, 5%). Management included non-operative/non-procedural treatment in 81 (40%), procedures in 35 (17%), and surgery in 86 (43%). Patients treated with non-operative/non-procedural, procedural, and surgical treatment demonstrated symptom improvement rates of 60% (49/81), 69% (24/35), and 78% (67/86), respectively. Surgical treatment was associated with symptom improvement (OR 2.3 [95% CI 1.2-4.5]) compared to non-operative/non-procedural management. Symptom improvement was associated with improved survival (HR 0.27 [95% CI 0.19-0.38]) on multivariate analysis. Conclusions Symptom improvement was obtained in the majority of patients regardless of treatment strategy. Although patients selected for surgery demonstrated an association with symptom improvement, future prospective studies are needed to determine additional variables important in treatment selection.

Original languageEnglish (US)
Pages (from-to)367-371
Number of pages5
JournalJournal of Surgical Oncology
Volume107
Issue number4
DOIs
StatePublished - Mar 2013

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Inpatients
Referral and Consultation
Survival
Neoplasms
Therapeutics
Gastrointestinal Hemorrhage
Enteral Nutrition
Malnutrition
Abdominal Pain
Medical Records
Multivariate Analysis
Prospective Studies
Wounds and Injuries

Keywords

  • advanced cancer
  • palliative care
  • surgery
  • surgical oncology

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Indicators of symptom improvement and survival in inpatients with advanced cancer undergoing palliative surgical consultation. / Badgwell, Brian D.; Aloia, Thomas A.; Garrett, John; Chedister, Gabe; Miner, Tom; Krouse, Robert S.

In: Journal of Surgical Oncology, Vol. 107, No. 4, 03.2013, p. 367-371.

Research output: Contribution to journalArticle

Badgwell, Brian D. ; Aloia, Thomas A. ; Garrett, John ; Chedister, Gabe ; Miner, Tom ; Krouse, Robert S. / Indicators of symptom improvement and survival in inpatients with advanced cancer undergoing palliative surgical consultation. In: Journal of Surgical Oncology. 2013 ; Vol. 107, No. 4. pp. 367-371.
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abstract = "Background The purpose of this study was to prospectively identify the presentation, treatment, and outcomes of inpatients with advanced malignancy undergoing palliative surgical consultation. Methods Inpatients undergoing palliative surgical consultation were prospectively identified from November 2008 to May 2011. Medical records were retrospectively reviewed to obtain clinical data and outcome. Results Of 202 consultations, the diagnoses were wound problems (N = 39, 19{\%}), bowel obstruction (N = 75, 37{\%}), intra-abdominal inflammatory conditions (N = 36, 18{\%}), abdominal pain of unclear etiology (N = 13, 6{\%}), gastrointestinal hemorrhage (N = 15, 7{\%}), malnutrition/feeding tube request (N = 14, 7{\%}), and biliary obstruction (N = 10, 5{\%}). Management included non-operative/non-procedural treatment in 81 (40{\%}), procedures in 35 (17{\%}), and surgery in 86 (43{\%}). Patients treated with non-operative/non-procedural, procedural, and surgical treatment demonstrated symptom improvement rates of 60{\%} (49/81), 69{\%} (24/35), and 78{\%} (67/86), respectively. Surgical treatment was associated with symptom improvement (OR 2.3 [95{\%} CI 1.2-4.5]) compared to non-operative/non-procedural management. Symptom improvement was associated with improved survival (HR 0.27 [95{\%} CI 0.19-0.38]) on multivariate analysis. Conclusions Symptom improvement was obtained in the majority of patients regardless of treatment strategy. Although patients selected for surgery demonstrated an association with symptom improvement, future prospective studies are needed to determine additional variables important in treatment selection.",
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