Surgery still common, but outcomes slightly better for terminal cancer
the ONA take:
Despite a greater focus on quality of life at the end of life, the number of patients with terminal cancer undergoing surgery has increased, according to a new study from UC Davis.
However, postsurgical morbidity and mortality for these patients has declined. One reason may be that healthier patients—patients are more independent and fewer experienced dramatic weight loss or sepsis—are selected for surgery.
The 5-year study involved 21,755 patients with stage IV cancer, selected from the American College of Surgeons National Surgical Quality Improvement Program, between 2006 and 2010.
During the study period, surgical interventions declined from 1.9% to 1.6% for all procedures. Morbidity decreased from 33.7% in 2006 to 26.6% in 2010; mortality also declined, from 10.4% to 9.3%.
In addition, the researchers found that just 3% of the patients with terminal cancer had Do Not Resuscitate (DNR) directives in place.
This finding implies that advanced directives and end-of-life discussions are possibly delayed. Lead study author, Sarah Bateni, a UC Davis resident surgeon, suggests that clinicians have a comprehensive discussion about end-of-life goals of care with patients as soon as cancer is diagnosed, especially with patients whose cancer has a high mortality rate, to ensure that palliative and hospice care are not delayed.
Despite a greater focus on quality of life at the end of life, the number of patients with terminal cancer undergoing surgery has increased.
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