Faculty Collaboration Database

Factors associated with palliative care use in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. J Surg Res 2017 May 01;211:79-86

Date

05/16/2017

Pubmed ID

28501134

DOI

10.1016/j.jss.2016.11.066

Scopus ID

2-s2.0-85008219883 (requires institutional sign-in at Scopus site)   8 Citations

Abstract

BACKGROUND: Peritoneal carcinomatosis represents widespread metastatic disease throughout the abdomen and/or pelvis. Cytoreductive surgery/hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) improves the overall survival compared to standard therapy alone. The role palliative care (PC) plays however, remains poorly studied among these patients.

METHODS: Patients who had previously undergone HIPEC and who underwent an inpatient admission from 7/1/2013 to 6/30/2014 were identified to determine which patients were referred for inpatient or outpatient palliative consultation. Multivariable logistic regression analysis was performed to identify risk factors associated with the use of PC.

RESULTS: Of the 60 patients analyzed, 23 (38.3%) had a PC consultation with a median time to PC referral of 310 (IQR: 151-484 days). Patients who were prescribed opioids (no PC referral versus PC referral: 46.0% versus 91.3%, P < 0.001), patients who reported the use of a cancer-related emetic (35.1% versus 87.0%, P < 0.001), patients reporting the use of total parenteral nutrition (16.2% versus 39.1%, P = 0.046), and patients dependent on a gastric tube for nutrition (5.4% versus 43.5%, P < 0.001) were more likely to be referred to a PC consultation. On multivariable analysis, use of opioids, use of a cancer-related antiemetic, and the use of a G-tube were independently associated with a greater odds for being referred to PC (all P < 0.05).

CONCLUSIONS: Approximately one-third of patients were referred to PC following cytoreductive surgery/hyperthermic intraperitoneal chemotherapy. Palliative care referrals were most commonly used for patients with chronic symptoms, which are difficult to manage, especially toward the end of life.

Author List

Morris RS, Gani F, Hammad AY, Peltier W, Gamblin TC, Turaga KK, Johnston FM

Authors

Thomas Clark Gamblin MD Professor in the Surgery department at Medical College of Wisconsin
Rachel S. Morris MD Assistant Professor in the Surgery department at Medical College of Wisconsin

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

Adult
Aged
Antineoplastic Combined Chemotherapy Protocols
Appendiceal Neoplasms
Chemotherapy, Cancer, Regional Perfusion
Colonic Neoplasms
Combined Modality Therapy
Cytoreduction Surgical Procedures
Female
Follow-Up Studies
Humans
Hyperthermia, Induced
Logistic Models
Male
Mesothelioma
Middle Aged
Ovarian Neoplasms
Palliative Care
Peritoneal Neoplasms
Referral and Consultation
Retrospective Studies
Sarcoma
Stomach Neoplasms