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Zongo N, Yameogo PB, Savadogo JT, Bagué AH, Dem A. The outcomes of palliative surgical treatment in a context of rising incidence of gastro intestinal cancers in Burkina Faso, Africa. Eur J Surg Oncol 2022; 48:2174-2180. [PMID: 35850944 DOI: 10.1016/j.ejso.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 07/03/2022] [Accepted: 07/04/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Digestive cancers are frequent and of late diagnosis in Africa. Palliative surgery therefore plays an important role. Our objective is to describe its indications, techniques and results in primary digestive cancers. METHODS Retrospective, bicentric, descriptive study of palliative surgery for primary digestive cancer, performed in Ouagadougou over the last twelve years. The results were assessed according to the degree of improvement in the patients' quality of life. We divided the patients into four groups according to the improvement of the quality of life after the operation. The results were considered very satisfactory when the symptoms disappeared completely. They were considered satisfactory when the symptoms decreased in intensity. They were unsatisfactory when the symptoms kept the same intensity. They were considered poor when the symptoms persisted with greater intensity. RESULTS Six hundred and thirty-nine palliative digestive cancer surgeries were performed. All patients had clinical symptoms deteriorating their quality of life (56.7%) or even a surgical emergency (43.3%). Biliodigestive diversion, gastroentero-anastomosis and colostomy were the palliative procedures performed respectively in 26.6%, 16.9%, and 34.1%. Complications were noted in 11.7%. These were digestive fistulas in 9 cases, retraction and stomal prolapse in 11 cases. The improvement of the quality of life was very satisfactory in 76%. CONCLUSIONS Palliative surgery is widely practiced in digestive cancers. It improves the quality of life. African surgeons should be aware and well-educated to safely perform surgical palliative procedures.
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Affiliation(s)
- Nayi Zongo
- Digestive and General Surgery, Yalgado Ouedraogo Teaching Hospital Ouagadougou, 03 BP 7021, Ouagadougou, Joseph Ki-Zerbo University, Burkina Faso.
| | - Parateyandé Bonaventure Yameogo
- Digestive and General Surgery, Yalgado Ouedraogo Teaching Hospital Ouagadougou, 03 BP 7021, Ouagadougou, Joseph Ki-Zerbo University, Burkina Faso
| | - Julien T Savadogo
- Digestive and General Surgery, Yalgado Ouedraogo Teaching Hospital Ouagadougou, 03 BP 7021, Ouagadougou, Joseph Ki-Zerbo University, Burkina Faso
| | - Abdoul Halim Bagué
- Digestive and General Surgery, Yalgado Ouedraogo Teaching Hospital Ouagadougou, 03 BP 7021, Ouagadougou, Joseph Ki-Zerbo University, Burkina Faso
| | - Ahmadou Dem
- Institut Joliot Curie de Dakar (Senegal), Cheikh Anta Diop University of Dakar, 10700, Dakar, Senegal
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Abstract
Surgical palliation in oncology can be defined as "procedures employed with non-curative intent with the primary goal of improving symptoms caused by an advanced malignancy," and is an important aspect of the end-of-life care of patients with incurable malignancies. Palliative interventions may provide great benefit, but they also carry high risk for morbidity and mortality, which may be minimized with careful patient selection. This can be done by consideration of the patient and his or her indication for the given intervention via open communication, as well as prediction of benefits and risks to define the therapeutic index of the operation or procedure.
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Affiliation(s)
- Cassandra S Parker
- Department of Surgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, 593 Eddy Street, APC 443, Providence, RI 02903, USA
| | - Thomas J Miner
- Department of Surgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, 593 Eddy Street, APC 443, Providence, RI 02903, USA.
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Baumgartner JM, Marmor R, Hsu A, Veerapong J, Kelly KJ, Lowy AM. Obstruction-Free Survival Following Operative Intervention for Malignant Bowel Obstruction in Appendiceal Cancer. Ann Surg Oncol 2019; 26:3611-3617. [PMID: 31190209 DOI: 10.1245/s10434-019-07507-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Patients with peritoneal metastases from appendiceal cancer are at high risk of malignant bowel obstruction (MBO), which is associated with significant morbidity and mortality. There are no definitive treatment guidelines regarding operative intervention for MBO. We sought to evaluate the efficacy and safety of operative intervention in this population. METHODS We identified patients with peritoneal metastases from appendiceal cancer who underwent surgery for MBO at our institution between 2011 and 2018. Baseline characteristics, postoperative complications, and follow-up data were collected. The primary endpoint was obstruction-free survival (OFS). Other endpoints were postoperative recovery of bowel function, 60-day Clavien-Dindo (CD) morbidity, and overall survival (OS). RESULTS Twenty-six patients underwent operative treatment for MBO, of whom 14 had high-grade (HG) histology and 12 had low-grade (LG) histology. Seven (25.9%) patients had severe (CD grade 3 or higher) 60-day complications, including one (3.8%) postoperative death. All remaining patients had return of bowel function and resumed oral intake during hospitalization. Six (23.1%) patients had repeat admissions for MBO after surgery. Median OFS was 17.0 months (95% confidence interval [CI] 2.3-31.8), and median OS was 18.5 months (95% CI 3.6-33.3) following surgery. CONCLUSION In this carefully selected group of patients with peritoneal metastases from appendiceal cancer, surgery for MBO provided durable palliation with acceptable morbidity.
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Affiliation(s)
- Joel M Baumgartner
- Department of Surgery, University of California, San Diego Moores Cancer Center, La Jolla, CA, USA.
| | - Rebecca Marmor
- Department of Surgery, University of California, San Diego Moores Cancer Center, La Jolla, CA, USA
| | - Athena Hsu
- Department of Surgery, University of California, San Diego Moores Cancer Center, La Jolla, CA, USA
| | - Jula Veerapong
- Department of Surgery, University of California, San Diego Moores Cancer Center, La Jolla, CA, USA
| | - Kaitlyn J Kelly
- Department of Surgery, University of California, San Diego Moores Cancer Center, La Jolla, CA, USA
| | - Andrew M Lowy
- Department of Surgery, University of California, San Diego Moores Cancer Center, La Jolla, CA, USA
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4
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Cohen JT, Miner TJ. Patient selection in palliative surgery: Defining value. J Surg Oncol 2019; 120:35-44. [DOI: 10.1002/jso.25512] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 03/25/2019] [Accepted: 04/22/2019] [Indexed: 12/27/2022]
Affiliation(s)
- Joshua T. Cohen
- Department of Surgery, Rhode Island HospitalWarren Alpert Medical School of Brown UniversityProvidence Rhode Island
| | - Thomas J. Miner
- Department of Surgery, Rhode Island HospitalWarren Alpert Medical School of Brown UniversityProvidence Rhode Island
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Xu MJ, Su D, Deboer R, Garcia M, Tahir P, Anderson W, Kinderman A, Braunstein S, Sherertz T. Palliative Oncologic Care Curricula for Providers in Resource-Limited and Underserved Communities: a Systematic Review. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2019; 34:205-215. [PMID: 29264703 DOI: 10.1007/s13187-017-1310-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Familiarity with principles of palliative care, supportive care, and palliative oncological treatment is essential for providers caring for cancer patients, though this may be challenging in global communities where resources are limited. Herein, we describe the scope of literature on palliative oncological care curricula for providers in resource-limited settings. A systematic literature review was conducted using PubMed, Embase, Cochrane Library, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Med Ed Portal databases, and gray literature. All available prospective cohort studies, case reports, and narratives published up to July 2017 were eligible for review. Fourteen articles were identified and referenced palliative care education programs in Argentina, Uganda, Kenya, Australia, Germany, the USA, or multiple countries. The most common teaching strategy was lecture-based, followed by mentorship and experiential learning involving role play and simulation. Education topics included core principles of palliative care, pain and symptom management, and communication skills. Two programs included additional topics specific to the underserved or American Indian/Alaskan Native community. Only one program discussed supportive cancer care, and no program reported educational content on resource-stratified decision-making for palliative oncological treatment. Five programs reported positive participant satisfaction, and three programs described objective metrics of increased educational or research activity. There is scant literature on effective curricula for providers treating cancer patients in resource-limited settings. Emphasizing supportive cancer care and palliative oncologic treatments may help address gaps in education; increased outcome reporting may help define the impact of palliative care curriculum within resource-limited communities.
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Affiliation(s)
- Melody J Xu
- Department of Radiation Oncology, University of California San Francisco, 1600 Divisadero St, San Francisco, CA, 94115, USA
- International Cancer Expert Corps, New York, NY, USA
| | - David Su
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Rebecca Deboer
- Department of Internal Medicine, Division of Hematology/Oncology, University of California San Francisco, San Francisco, CA, USA
| | - Michael Garcia
- Department of Radiation Oncology, University of California San Francisco, 1600 Divisadero St, San Francisco, CA, 94115, USA
| | - Peggy Tahir
- Department of Library, University of California San Francisco, San Francisco, CA, USA
| | - Wendy Anderson
- Department of Internal Medicine, Division of Hospital Medicine and Palliative Care, University of California San Francisco, San Francisco, CA, USA
| | - Anne Kinderman
- Department of Internal Medicine, Division of Hospital Medicine and Palliative Care, University of California San Francisco, San Francisco, CA, USA
- Supportive and Palliative Care Service, San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
| | - Steve Braunstein
- Department of Radiation Oncology, University of California San Francisco, 1600 Divisadero St, San Francisco, CA, 94115, USA
| | - Tracy Sherertz
- Department of Radiation Oncology, University of California San Francisco, 1600 Divisadero St, San Francisco, CA, 94115, USA.
- International Cancer Expert Corps, New York, NY, USA.
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Grover S, Xu M, Jhingran A, Mahantshetty U, Chuang L, Small W, Gaffney D. Clinical trials in low and middle-income countries - Successes and challenges. Gynecol Oncol Rep 2017; 19:5-9. [PMID: 28004030 PMCID: PMC5157789 DOI: 10.1016/j.gore.2016.11.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Revised: 11/12/2016] [Accepted: 11/21/2016] [Indexed: 12/23/2022] Open
Abstract
Gynecologic malignancies affect women in low and middle-income countries (LMICs) at equal or higher rates compared to high income countries (HICs), yet practice guidelines based on clinical trials performed in HICs do not routinely account for resource disparities between these regions. There is a need and growing interest for executing clinical trials in LMICs. This has led to the creation of multinational cooperative groups and the initiation of several ongoing clinical trials in Mexico, China, and Korea. In this article we describe the challenges involved in initiating clinical trials in LMICs, review current efforts within surgical, medical, and radiation oncology, and introduce high priority topics for future research.
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Affiliation(s)
- Surbhi Grover
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, United States
| | - Melody Xu
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, United States
| | - Anuja Jhingran
- Division of Radiation Oncology, MD Anderson Cancer Center, University of Texas, Houston, TX, United States
| | - Umesh Mahantshetty
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Linus Chuang
- Department of Gynecological Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - William Small
- Department of Radiation Oncology, Loyola University, Chicago, IL, United States
| | - David Gaffney
- Department of Radiation Oncology, University of Utah, Salt Lake City, UT, United States
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