Can patient reported outcomes help identify the optimal outcome in palliative surgery?

Abstract

An open-ended questionnaire can identify severe symptoms that a global quality of life survey cannot capture and could be used in conjunction with a global survey to reassess symptoms after palliative surgical consultation.

Current perioperative outcomes for patients with disseminated cancer

“…Prior to and during this time period, studies have supported the concept that the performance of palliative operations may provide effective symptom relief in patients with advanced malignancies [2, 5, 19]. These and other studies may have supported the decision of surgeons, patients and families to undergo surgical intervention [20]. Furthermore, surgeons as well as other clinicians have been observed to be overly optimistic when estimating life expectancy among patients with advanced malignancy, including in cases where surgical intervention is contemplated [5, 21].…”

Palliative Care in Surgery

“…Future studies need to characterize patients’ perspectives on the benefits, burdens, and tradeoffs associated with surgery and how best to measure the outcomes that are most meaningful to them. 34,35…”

“…Palliative surgical procedures are intended to reduce suffering or support quality of life rather than prolong life or cure disease. 34,35,47 Prior studies have described the considerable risks of postoperative complications and mortality after palliative surgery, but few have measured the impact of palliative surgery on restoration of function and quality of life, or conversely, the occurrence of adverse outcomes that further threaten quality of life, function, and ability to achieve a good death. 26,48 Absence of a uniform system for designating and classifying procedures performed with palliative intent presents a barrier to studying outcomes of palliative surgery.…”

Palliative Surgery: Incidence and Outcomes

“…Unfortunately, the literature frequently focuses exclusively on survival as an endpoint, leaving clinicians with little information on an intervention's impact on QOL. 7 A major dilemma in palliative surgery is the identification of measures of success. The surgical literature has been a poor guide for decision-making for this population of patients.…”

“…While it is imperative to understand these outcomes, they should not be the primary focus of palliative procedures, as they may not equate with an improvement in QOL. 7 A series of studies conducted at the City of Hope focused on describing patient and family caregiver needs, decisions, and outcomes related to palliative surgery. The Decisions and Outcomes of Palliative Surgery (DOPS) study aimed to describe symptom relief and QOL in patients and family caregivers are not undergoing palliative surgery.…”