- Terminally ill cancer patients are diagnosed with bowel obstruction
- Postoperative patients with stage 4 cancer have increased rates of prolonged hospital stay
- Surgeons need to talk with terminally ill patients about end of life goals, risks and benefits of surgery
Advanced cancer patients who undergo surgery are far more likely to endure long hospital stays and readmissions, find UC Davis researchers.
The study highlights the dilemma physicians face when their terminally ill cancer patients are diagnosed with bowel obstruction that may benefit from surgery as well as the need for discussions about the surgery risks and implications on future quality of life.
‘Patients with stage 4 cancer spent more time in the hospital, had higher mortality within 30 days of procedure than their counterparts who didn’t have stage 4 cancer.’
Bowel obstruction happens when the small or the large intestine is partly or completely blocked. The blockage prevents the movement of food, fluids and gas through the intestines in the normal way. The blockage causes severe pain in terminally ill cancer patients.
"We commonly consult with patients who have acute surgical conditions and advanced cancer, and it has left us to weigh the risks and benefits of surgical intervention," said lead author Sarah B. Bateni, a fourth-year surgery resident. "It's important carefully examine their risks before proposing surgery, and to understand what their goals of care are for their remaining days."Study
Case histories of approximately 18,000 patients who had stage 4 (metastatic) cancer who went on to undergo surgery were examined. The cases were matched with patients who had similar characteristics such as age, gender and functional status before surgery and underwent similar operations but did not have stage 4 cancer.
Results of the Study:
The study results revealed the following:
Patients with stage 4 cancer -
- Spent more time in the hospital
- Were readmitted to the hospital more frequently
- Were more often referred to another facility such as skilled nursing
- Had higher mortality within 30 days of the procedure
Scientists noted that patients with stage 4 cancer who didn't have any complications during their hospital stay also ended up staying in hospital longer and had higher 30-day mortality compared to patients who didn't have stage 4 cancer.
"This diagnosis really is an indicator of the frailty of these patients and is itself a risk factor for readmission, prolonged stays in the hospital and discharge to other facilities," she said.
"We all need to clarify the goals of care for patients with advanced cancer prior to providing - or even discussing - the potential surgical interventions," she said.
Bateni and her co-authors conclude that doctors and surgeons need to talk with their terminally ill cancer patients about their end-of-life goals, palliative care and the risks and benefits of surgery.
Study published in PLOS ONE