Medical College of Wisconsin
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Invasive procedures in the elderly after stage IV cancer diagnosis. J Surg Res 2015 Feb;193(2):754-63

Date

09/23/2014

Pubmed ID

25234747

Pubmed Central ID

PMC4791166

DOI

10.1016/j.jss.2014.08.021

Scopus ID

2-s2.0-84916919263   11 Citations

Abstract

BACKGROUND: Invasive procedures are resource intense and may be associated with substantial morbidity. These harms must be carefully balanced with the benefits gained in life expectancy and quality of life. Prior research has demonstrated an increasing aggressiveness of care in cancer patients at the end-of-life. To better characterize surgical care in this setting, we sought to examine trends in the use of invasive procedures in patients diagnosed with metastatic cancer on presentation.

MATERIALS AND METHODS: Using Surveillance Epidemiology and End Results -Medicare data, we identified invasive procedure claims from 1994-2009 for patients diagnosed with incident stage IV breast, colorectal, lung, and prostate cancer patients in 1995-2006. We grouped procedures into surgically relevant categories, using an adaptation of the Clinical Classifications Software, and measured utilization and relative changes over time.

RESULTS: Of stage IV patients diagnosed in 2002-2006, 96% underwent a procedure during the course of their cancer care including 63% after the diagnostic period, and 25% in the last month of life. Between 1996 and 2006, minimal change was observed in utilization during the diagnostic period (+1.5%). However, there were significant increases during continuing care (+20.7%) and the last month of life (+21.5%). Procedures consistent with primary tumor resection decreased, whereas those with probable palliative intent and those unrelated to cancer increased.

CONCLUSIONS: Nearly all patients who present with metastatic cancer undergo invasive procedures. Although overall utilization is increasing, the specific procedure types indicate that it may be appropriate, enhancing the quality of life in this vulnerable population.

Author List

Kwok AC, Hu YY, Dodgion CM, Jiang W, Ting GV, Taback N, Lipsitz SR, Weeks JC, Greenberg CC

Author

Christopher M. Dodgion MD Associate Professor in the Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Aged
Aged, 80 and over
Female
Humans
Life Expectancy
Male
Neoplasms
SEER Program
Surgical Procedures, Operative
Terminal Care