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Boland EG, Tay KT, Khamis A, Murtagh FEM. Patterns of acute hospital and specialist palliative care use among people with non-curative upper gastrointestinal cancer. Support Care Cancer 2024; 32:432. [PMID: 38874678 PMCID: PMC11178555 DOI: 10.1007/s00520-024-08624-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 06/01/2024] [Indexed: 06/15/2024]
Abstract
PURPOSE Upper gastrointestinal (GI) cancers contribute to 16.7% of UK cancer deaths. These patients make high use of acute hospital services, but detail about palliative care use is lacking. We aimed to determine the patterns of use of acute hospital and hospital specialist palliative care services in patients with advanced non-curative upper GI cancer. METHODS We conducted a service evaluation of hospital use and palliative care for all patients with non-curative upper GI cancer seen in one large hospital, using routinely collected data (2019-2022). We report and characterise hospital admissions and palliative care within the study time period, using descriptive statistics, and multivariable Poisson regression to estimate the unadjusted and adjusted incidence rate ratio of hospital admissions. RESULTS The total with non-curative upper GI cancer was 960. 86.7% had at least one hospital admission, with 1239 admissions in total. Patients had a higher risk of admission to hospital if: aged ≤ 65 (IRR for 66-75 years 0.71, IRR 76-85 years 0.68; IRR > 85 years 0.53; p < 0.05), or lived in an area of lower socioeconomic status (IMD Deciles 1-5) (IRR 0.90; p < 0.05). Over the 4-year period, the rate of re-admission was higher in patients not referred to palliative care (rate 0.52 readmissions/patient versus rate 1.47 readmissions/patient). CONCLUSION People with advanced non-curative gastrointestinal cancer have frequent hospital admissions, especially if younger or from areas of lower socioeconomic status. There is clear association between specialist palliative care referral and reduced risk of hospitalisation. This evidence supports referral to specialist palliative care.
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Affiliation(s)
- E G Boland
- Hull University Teaching Hospitals NHS Trust, Hull, UK.
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK.
| | - K T Tay
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - A Khamis
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - F E M Murtagh
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
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Maddalon B, Cenzi C, Tonello M, Pizzolato E, Barina A, De Simoni O, Franzato B, Gruppo M, Mattara G, Tolin F, Moretto V, Nardi M, Zagonel V, Pilati P, Sommariva A. Clinical benefits of symptom resolution after palliative surgery in advanced cancer: A single-center experience. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108368. [PMID: 38723448 DOI: 10.1016/j.ejso.2024.108368] [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: 02/27/2024] [Revised: 04/13/2024] [Accepted: 04/23/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Palliative surgery (PS) is defined as any surgical procedure aimed at improving quality of life or relieving symptoms caused by an advanced or metastatic cancer. The involvement of patients, caregivers, and other professional figures is crucial for obtaining optimal symptom relief and avoiding complications. This study aims to evaluate the short-term outcome and related factors in patients undergoing PS. PATIENTS AND METHODS A retrospective analysis was performed in consecutive patients who underwent palliative gastrointestinal surgery at our surgical unit during the period June 2018 to May 2023. Demographic, clinical, pathological and follow-up data were collected from a prospectively maintained department database. The main outcomes were complications, symptoms palliation, symptoms recurrence and return to systemic chemotherapy. Standard statistical analysis was performed. RESULTS During the study period, 127 patients underwent palliative surgery. The Clavien-Dindo 3-5 complication rate and mortality rate were 19.7 % and 6 %, respectively. The resolution of symptoms was achieved in 109 patients (89 %). Successful symptom palliation was significantly related to the possibility of returning to systemic chemotherapy (SC) (OR 9.30 95 % CI 0.1.83-47.18, p 0.007). The only factor related to survival in multivariate analysis was the return to systemic chemotherapy (HR 0.25 95 % CI 0.15-0.42 0.001). CONCLUSION PS in selected patients is effective for symptom resolution and improving overall survival, if the result is making anticancer therapy possible. Prospective data collection is in any case warranted in every institution performing PS for the purpose of monitoring appropriateness and quality of surgical care.
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Affiliation(s)
- Beatrice Maddalon
- Surgical Oncology of Digestive Tract, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Carola Cenzi
- Clinical Research Unit, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Marco Tonello
- Surgical Oncology of Digestive Tract, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Elisa Pizzolato
- Surgical Oncology of Digestive Tract, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Andrea Barina
- Surgical Oncology of Digestive Tract, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Ottavia De Simoni
- Surgical Oncology of Digestive Tract, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Boris Franzato
- Surgical Oncology of Digestive Tract, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Mario Gruppo
- Surgical Oncology of Digestive Tract, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Genny Mattara
- Surgical Oncology of Digestive Tract, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Francesca Tolin
- Surgical Oncology of Digestive Tract, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Valentina Moretto
- Nutritional Support Unit, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Mariateresa Nardi
- Nutritional Support Unit, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Vittorina Zagonel
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Pierluigi Pilati
- Surgical Oncology of Digestive Tract, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Antonio Sommariva
- Surgical Oncology of Digestive Tract, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy.
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Soon JJY, Juan DWK, Ong WS, Bek S, Neo PSH, Salazar E, Da Zhuang K, Tan YP, Seo CJ, Ong JCA, Chia CS, Wong JSM. Implementation of a Multi-Disciplinary Team and Quality of Goals of Care Discussions in Palliative Surgical Oncology Patients. Ann Surg Oncol 2023; 30:8054-8060. [PMID: 37672144 PMCID: PMC10625938 DOI: 10.1245/s10434-023-14190-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 07/24/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND Palliative surgical oncology patients represent a unique group with complex needs who often require multidisciplinary input for the provision of timely and holistic care. The authors assembled a multi-disciplinary palliative intervention team and evaluated its association with the quality of discussions on goals of care (GOC) among advanced cancer patients undergoing palliative interventions. METHODS This prospective cohort study analyzed advanced cancer patients undergoing palliative interventions at a single urban academic center from October 2019 to March 2022. In January 2021, a multi-disciplinary palliative surgical intervention (MD-PALS) team was assembled. All palliative surgical oncology patients were discussed at multi-disciplinary meetings and managed by members of the MD-PALS team. An interrupted time series (ITS) model was built to evaluate the association of MD-PALS implementation and the quality of GOC discussions as measured by a consensus-derived four-point GOC discussion quality score. RESULTS The study recruited 126 palliative surgical oncology patients: 44 in the pre-MD-PALS group and 82 in the post-MD-PALS group. The two groups did not differ significantly in baseline demographics, treatment, or postoperative and survival outcomes. Compared with the pre-MD-PALS group, the post-MD-PALS group had a significantly higher mean GOC discussion quality score (1.34 vs 2.61; p < 0.001). Based on the ITS model, the average quarterly GOC discussion quality score increased significantly among patients after implementation of the MD-PALS team (change = 1.93; 95 % confidence interval, 0.96-2.90; P = 0.003). CONCLUSION The implementation of an MD-PALS team was associated with improvements in the quality of GOC discussions among palliative surgical oncology patients.
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Affiliation(s)
- Joel J Y Soon
- Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore, Singapore
| | - Darryl W K Juan
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore, Singapore
| | - Whee S Ong
- Division of Clinical Trials and Epidemiological Sciences, National Cancer Centre Singapore, Singapore, Singapore
| | - Schin Bek
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Patricia S H Neo
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
| | - Ennaliza Salazar
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore, Singapore
| | - Kun Da Zhuang
- Vascular and Interventional Radiology, Singapore General Hospital, Singapore, Singapore
| | - Yee Pin Tan
- Department of Psychosocial Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Chin Jin Seo
- Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore, Singapore
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore, Singapore
| | - Johnny C A Ong
- Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore, Singapore
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore, Singapore
- Duke-NUS Medical School, SingHealth Duke-NUS Oncology Academic Clinical Program, Singapore, Singapore
- Duke-NUS Medical School, SingHealth Duke-NUS Surgery Academic Clinical Program, Singapore, Singapore
- Laboratory of Applied Human Genetics, Division of Medical Sciences, National Cancer Centre Singapore, Singapore, Singapore
- Institute of Molecular and Cell Biology, A*STAR Research Entities, Singapore, Singapore
| | - Claramae S Chia
- Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore, Singapore
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore, Singapore
- Duke-NUS Medical School, SingHealth Duke-NUS Oncology Academic Clinical Program, Singapore, Singapore
| | - Jolene S M Wong
- Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore, Singapore.
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore.
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore, Singapore.
- Duke-NUS Medical School, SingHealth Duke-NUS Oncology Academic Clinical Program, Singapore, Singapore.
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Chen VW, Portuondo JI, Cooper Z, Massarweh NN. Variation in hospital utilization of palliative interventions for patients with advanced gastrointestinal cancer near end of life. J Surg Oncol 2023; 127:741-751. [PMID: 36514285 DOI: 10.1002/jso.27177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/31/2022] [Accepted: 12/04/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Patients with advanced gastrointestinal (GI) cancer often undergo noncurative interventions with palliative intent to relieve high symptom burden near end of life. Hospital-level variation in intervention utilization remains unclear. METHODS National cohort study of 142 304 patients with stage III or IV GI cancer within the National Cancer Database (2004-2014) who died within 1-year of diagnosis. Hospitals were stratified by palliative intervention utilization (surgery, chemotherapy, radiation, pain management). Multivariable, multinomial regression evaluated the association between patient/hospital factors and palliative intervention utilization. RESULTS Across 1322 hospitals, median hospital palliative intervention utilization was 12.0% [interquartile range: 0.0%-26.1%]. Utilization increased over time in all but lowest utilizing hospitals. Relative to lowest utilizing hospitals, factors associated with a lower likelihood of care at highest utilizing hospitals included: race (White [ref]; Black-Relative Risk Ratio [RRR] 0.81, 95% confidence interval [0.77-0.85]) and lower income (RRR 0.81 [0.78-0.84]). Factors associated with a higher likelihood included: lower education level (RRR 1.62 [1.55-1.69]) and hospital type (community program [ref]; comprehensive community-RRR 1.33 [1.26-1.41]; academic-RRR 1.88 [1.77-1.99]; integrated network-RRR 1.79 [1.66-1.93]). CONCLUSION Hospital variation in palliative intervention use is substantial and potentially associated with sociodemographic and hospital characteristics. Future work can examine how differences in hospital care processes translate to quantity/quality of life for cancer patients.
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Affiliation(s)
- Vivi W Chen
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E DeBakey VA Medical Center, Houston, Texas, USA.,Michael E DeBakey Department of Surgery at Baylor College of Medicine, Houston, Texas, USA
| | - Jorge I Portuondo
- Michael E DeBakey Department of Surgery at Baylor College of Medicine, Houston, Texas, USA
| | - Zara Cooper
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Nader N Massarweh
- Surgical and Perioperative Care, Atlanta VA Health Care System, Decatur, Georgia, USA.,Department of Surgery, Division of Surgical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Surgery, Morehouse School of Medicine, Atlanta, Georgia, USA
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Chen VW, Massarweh NN. ASO Author Reflections: Palliative Interventions in Cancer Care Within the Last Year of Life: Unnecessary or Underutilized? Ann Surg Oncol 2022; 29:7293-7294. [PMID: 35933544 DOI: 10.1245/s10434-022-12344-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 07/15/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Vivi W Chen
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA. .,Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
| | - Nader N Massarweh
- Surgical and Perioperative Care, Atlanta VA Health Care System, Decatur, GA, USA.,Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA.,Department of Surgery, Morehouse School of Medicine, Atlanta, GA, USA
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