Specialized palliative care for patients undergoing major abdominal surgery for cancer


By Matthew Stenger

Posted: 2023/5/19 10:28:00 AM

Last update: 2023/5/19 9:39:51 AM

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In a single-center study reported in JAMA surgeryShinall et al. found that specialist palliative care did not improve quality of life or survival compared with usual care in patients undergoing nonpalliative abdominal surgery for cancer.

Research details

In this trial, 235 patients scheduled for specific intra-abdominal cancer surgery at Vanderbilt University Medical Center were enrolled between March 2018 and October 2021 in specialized palliative care interventions (n ​​= 117) or as usual care (n = 118). Patients had one of the following surgeries: partial or total gastrectomy, partial hepatectomy, partial or total pancreatic resection, partial or total colectomy, or rectectomy, Radical cystectomy, pelvicectomy, cytoreductive surgery after neoadjuvant therapy for ovarian or endometrial cancer, or cytoreductive surgery. Hyperthermia intraperitoneal chemotherapy.

This intervention consisted of a preoperative consultation with a palliative care specialist and postoperative inpatient and outpatient 90-day palliative care follow-up. The primary endpoint was physical and functional quality of life at 90 days after surgery, as measured by the Cancer Care Global Functional Assessment (FACT-G) Test Outcome Index (TOI). The index is scored from 0 to 56, with higher scores representing better physical and functional quality of life.

Main findings

The median adjusted score of the FACT-G TOI scale for physical and functional quality of life at 90 days was 46.77 (95% confidence interval) [CI] = 44.18–49.04) intervention group vs. usual care group 46.23 (95% CI = 43.08–48.14) (odds ratio) [OR] = 1.17, 95% CI = 0.77–1.80, P. = .46).

No significant difference was observed between intervention and usual care groups in overall quality of life as measured by FACT-G scores after 90 days (OR = 1.09, 95% CI = 0.75-1.58). Between the intervention and usual care groups, survival at home to day 90 (median = 84 vs 83; OR = 0.87, 95% CI = 0.69–1.11) or 1-year overall survival (hazard ratio = 0.97, 95% CI = 0.50–1.88).

The researchers concluded, “This randomized clinical trial showed no evidence that early specialized palliative care improves quality of life for patients undergoing nonpalliative cancer surgery.”

Myrick C. Cinal Jr., M.D., Ph.D.Vanderbilt University Medical Center Department of General Surgery is the corresponding author of this paper. JAMA surgery article.

Disclosure: This study was funded by a grant from the National Institutes of Health. For full disclosures of study authors, please visit jamanetwork.com.

The content of this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the views or opinions of ASCO®.




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