Surgery for Terminally Ill Cancer Patients Remains Prevalent

Although 30-day morbidity and mortality have all declined incrementally for terminally ill cancer patients undergoing surgical intervention, the number of surgeries remains high, according to a study from University of California, Davis Health System (UC Davis). The paper was published in the Journal of Surgical Research.

According to the authors, the decrease in the rate of morbidity and mortality can be attributed to the fact that although surgical intervention remains prevalent, surgeons are selecting to operate on healthier patients. Overall, surgical interventions declined from 1.9% to 1.6% of all procedures.

“Surgeons are becoming wiser,” study lead author Sarah Bateni, a UC Davis resident surgeon, said in a statement. “Our research suggests that surgeons may be operating on healthier patients who are more likely to recover well from an operation. These are patients who can perform activities of daily living without assistance, for example.”

The researchers used data from the American College of Surgeons National Surgical Quality Improvement Program from 2006-2010. They identified 21,755 patients with stag IV cancer.

The most common operations performed on terminally ill cancer patients were bowel resection, other gastrointestinal procedures, and multiviseral resections. The rate of emergency operations also declined during this time.

The rate of morbidity decreased from 33.7% in 2006 to 26.6% in 2010. The rate of mortality declined more modestly from 10.4% to 9.3%. There are several reasons why surgeons continue to operate on terminally ill patients who are at high risk for complications and death, according to the authors.

“Some of it has to do with the patients and families,” Dr Bateni said. “If the patient is uncomfortable, the family wants a solution. In some cases, the surgeon also may be too optimistic about what the surgical outcome will be.”

Over the 5-year study period, the researchers found that independent function status among rose while the rate of weight loss and serious blood infection, characteristics associated with poor surgical outcomes, fell.

They also reported that just 3% of patients with terminal cancer had Do Not Resuscitate directives in place when they underwent surgery, which implies patients, families, and providers are often delaying end-of-life discussions.

“It’s really important that the doctor has an end-of-life, goals-of-care discussion prior to the time that the patient comes into the hospital with an acute illness,” Dr Bateni said. ”Patients should be referred to a palliative care counselor or have a comprehensive end-of-life discussion to ensure that their goals are respected as soon as they are diagnosed with cancer, especially those with cancers that have a high mortality rate.”