Clinical Research for Surgeons in Palliative Care: Challenges and Opportunities

Easson, Alexandra; Lee, K.Francis; Brasel, Karen J.; Krouse, Robert S.

doi:10.1016/s1072-7515(02)01703-9

Cited by 29 publications

(9 citation statements)

References 94 publications

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“…Typically, the clinical outcomes of SEMS treatment have been evaluated by the physician [9]; only a few prospective studies reported repeated symptom assessments by the patient [10–16]. Since patients’ and physicians’ ratings of treatment effects do not always correspond well, palliative treatment efforts such as SEMS for malignant GI obstructions should be evaluated by individual outcome measures reported by the patients as well as by the physicians [17–22]. …”

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confidence: 99%

Patient-reported outcomes in palliative gastrointestinal stenting: a Norwegian multicenter study

et al. 2011

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BackgroundThe clinical effect of stent treatment has been evaluated by mainly physicians; only a limited number of prospective studies have used patient-reported outcomes for this purpose. The aim of this work was to study the clinical effect of self-expanding metal stents in treatment of malignant gastrointestinal obstructions, as evaluated by patient-reported outcomes, and compare the rating of the treatment effect by patients and physicians.MethodsBetween November 2006 and April 2008, 273 patients treated with SEMS for malignant GI and biliary obstructions were recruited from nine Norwegian hospitals. Patients and physicians assessed symptoms independently at the time of treatment and after 2 weeks using the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire supplemented with specific questions related to obstruction.ResultsA total of 162 patients (99 males; median age = 72 years) completed both assessments and were included in the study. A significant improvement in the mean global health score was observed after 2 weeks (from 9 to 18 on a 0–100 scale, P < 0.03) for all stent locations. Both patients and physicians reported a significant reduction in all obstruction-related symptoms (>20 on the 0–100 scale, P < 0.006) after SEMS treatment. The physicians reported a larger mean improvement in symptoms than did the patients, mainly because they reported more severe symptoms before treatment.ConclusionSEMS treatment is effective in relieving symptoms of malignant GI and biliary obstruction, as reported by patients and physicians. The physicians, however, reported a larger reduction in obstructive symptoms than did the patients. A prospective assessment of patient-reported outcomes is important in evaluating SEMS treatment.

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confidence: 99%

Patient-reported outcomes in palliative gastrointestinal stenting: a Norwegian multicenter study

et al. 2011

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“…During the past 50 years, very little attention has been paid in the literature to this group of not surgically treated patients and data on which to base sound surgical choices are needed. 11,12 Based on this population-based complete national cohort of consecutive patients prospectively recorded in the clinical database of the Norwegian Rectal Cancer Registry (NRCR), we address various aspects of importance for palliative care to improve the understanding and scientific basis for clinical decisionmaking in patients with a short life expectation, and often a difficult daily life.…”

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confidence: 99%

Clinical Characteristics and Outcomes in Patients with Advanced Rectal Cancer: A National Prospective Cohort Study

Sigurðsson¹,

Kørner²,

Dahl³

et al. 2007

Diseases of the Colon &Amp; Rectum

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Higher age and comorbidity seem to influence choice of treatment in this subgroup of patients with advanced rectal cancer disease. In nonsurgically treated patients, radiotherapy was associated with an improved survival. Our prospective, population-based cohort study emphasizes the dismal prognosis of these patients, which also should challenge our efforts and clinical approaches in palliative care.

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“…There is a growing body of literature describing palliative management from the surgeon's perspective with a focus mainly on surgical oncology. [20][21][22][23][24] Given that the annual mortality rates of patients with PAD and foot wounds is typically at generally 12% and nearer to 20% for those that are elderly, palliative options may be as applicable to patients with PAD as to patients with terminal cancers. It should be emphasized that palliative management should be used only selectively and as an alternative to major amputation in the context of limbthreatening foot infections.…”

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confidence: 99%

Minor Amputation and Palliative Wound Care as a Strategy to Avoid Major Amputation in Patients With Foot Infections and Severe Peripheral Arterial Disease

Barshes

Gold

Garcia

et al. 2014

The International Journal of Lower Extremity Wounds

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Foot infections occurring in patients with severe peripheral arterial disease (PAD) who are not considered candidates for revascularization and limb salvage efforts are generally treated with major amputations. Herein we describe our early experiences in managing foot infections with minor amputations and palliative wound care as a strategy to avoid the functional disability often associated with major amputations. Patients with severe PAD that underwent minor amputations and subsequent palliative wound care for moderate/severe infections were paired with age-matched controls with PAD that underwent primary major amputations for foot infections. Eleven patients who underwent minor amputations and palliative wound care of 13 limbs were compared to an age-matched cohort of 12 patients undergoing 13 major amputations.The median age was 80 years in both groups. Survival at 1 and 2 years did not differ significantly between groups. All patients who were ambulatory and/or independently living remained so following palliative management; in contrast, major amputation changed ambulatory status in 75% of patients and independent living status in 50%. Palliative management did not result in ascending/systemic sepsis or progressive necrosis. The need for reoperations was uncommon in both groups. In summary, minor amputations and operative drainage with subsequent palliative wound care appears to be a safe management option in patients with severe PAD and moderate or severe foot infections that are not candidates for revascularization. Palliative management may result in less functional impairment than major amputation.

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Clinical Research for Surgeons in Palliative Care: Challenges and Opportunities

Cited by 29 publications

References 94 publications

Patient-reported outcomes in palliative gastrointestinal stenting: a Norwegian multicenter study

Patient-reported outcomes in palliative gastrointestinal stenting: a Norwegian multicenter study

Clinical Characteristics and Outcomes in Patients with Advanced Rectal Cancer: A National Prospective Cohort Study

Minor Amputation and Palliative Wound Care as a Strategy to Avoid Major Amputation in Patients With Foot Infections and Severe Peripheral Arterial Disease

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