Vivi W Chen1,2, Jorge I Portuondo3, Zara Cooper4,5, Nader N Massarweh6,7,8. 1. Center for Innovations in Quality, Effectiveness, and Safety, Michael E DeBakey VA Medical Center, Houston, TX, USA. Vivi.Chen@bcm.edu. 2. Michael E. DeBakey VA Medical Center, Department of Surgery at Baylor College of Medicine, Houston, TX, USA. Vivi.Chen@bcm.edu. 3. Michael E. DeBakey VA Medical Center, Department of Surgery at Baylor College of Medicine, Houston, TX, USA. 4. Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA. 5. Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA. 6. Surgical and Perioperative Service, Atlanta VA Health Care System, Decatur, GA, USA. 7. Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA. 8. Department of Surgery, Morehouse School of Medicine, Atlanta, GA, USA.
Abstract
BACKGROUND: Despite the well-established benefits of palliative care, little is known about the use of palliative interventions among patients with advanced gastrointestinal (GI) cancer near the end of life (EOL). METHODS: A national cohort study analyzed 142,304 patients with advanced GI cancers (stage 3 or 4) near EOL (death within 1 year of diagnosis) in the National Cancer Database (2004-2014) who received palliative interventions (defined as treatment to relieve symptoms: surgery, radiation, chemotherapy, and/or pain management). The study used multivariable hierarchical regression evaluate the association between the use of palliative interventions, temporal trends, and patient and hospital factors. RESULTS: Overall, 16.5% of the patients were treated with a palliative intervention, and use increased over time (13.4% in 2004 vs 19.8% in 2014; trend test, p < 0.001). Palliative interventions were used most frequently for esophageal cancer (20.6%) and least frequently for gallbladder cancer (13.3%). Palliative interventions were associated with younger age (odds ratio [OR], 0.99; 95% confidence interval [CI], 0.98-0.99), recent diagnosis year (OR, 1.05; 95% CI, 1.04-1.06), black race (white [ref]; OR, 1.07; 95% CI, 1.01-1.12), insurance status (no insurance [ref]; private: OR, 0.92; 95% CI ,0.95-0.99), hospital type (community cancer program [ref]; integrated network cancer programs: OR, 1.37; 95% CI ,1.07-1.75), and stage 4 disease (OR, 2.17; 95% CI, 2.07-2.27). Patients in southern and western regions were less likely to receive palliative intervention (Northeast [ref]; OR, 0.76; 95% CI, 0.62-0.94 and OR 0.46; 95% CI, 0.37-0.57, respectively). CONCLUSION: Increased palliative intervention use over time suggests ongoing changes in how care is delivered to GI cancer patients toward EOL. However, sociodemographic and geographic variation suggests opportunities to address barriers to optimal EOL care.
BACKGROUND: Despite the well-established benefits of palliative care, little is known about the use of palliative interventions among patients with advanced gastrointestinal (GI) cancer near the end of life (EOL). METHODS: A national cohort study analyzed 142,304 patients with advanced GI cancers (stage 3 or 4) near EOL (death within 1 year of diagnosis) in the National Cancer Database (2004-2014) who received palliative interventions (defined as treatment to relieve symptoms: surgery, radiation, chemotherapy, and/or pain management). The study used multivariable hierarchical regression evaluate the association between the use of palliative interventions, temporal trends, and patient and hospital factors. RESULTS: Overall, 16.5% of the patients were treated with a palliative intervention, and use increased over time (13.4% in 2004 vs 19.8% in 2014; trend test, p < 0.001). Palliative interventions were used most frequently for esophageal cancer (20.6%) and least frequently for gallbladder cancer (13.3%). Palliative interventions were associated with younger age (odds ratio [OR], 0.99; 95% confidence interval [CI], 0.98-0.99), recent diagnosis year (OR, 1.05; 95% CI, 1.04-1.06), black race (white [ref]; OR, 1.07; 95% CI, 1.01-1.12), insurance status (no insurance [ref]; private: OR, 0.92; 95% CI ,0.95-0.99), hospital type (community cancer program [ref]; integrated network cancer programs: OR, 1.37; 95% CI ,1.07-1.75), and stage 4 disease (OR, 2.17; 95% CI, 2.07-2.27). Patients in southern and western regions were less likely to receive palliative intervention (Northeast [ref]; OR, 0.76; 95% CI, 0.62-0.94 and OR 0.46; 95% CI, 0.37-0.57, respectively). CONCLUSION: Increased palliative intervention use over time suggests ongoing changes in how care is delivered to GI cancer patients toward EOL. However, sociodemographic and geographic variation suggests opportunities to address barriers to optimal EOL care.
Authors: Shaila J Merchant; Susan B Brogly; Christopher M Booth; Craig Goldie; Sulaiman Nanji; Sunil V Patel; Katherine Lajkosz; Nancy N Baxter Journal: Ann Surg Oncol Date: 2019-04-09 Impact factor: 5.344
Authors: Joan D Penrod; Partha Deb; Carol Luhrs; Cornelia Dellenbaugh; Carolyn W Zhu; Tsivia Hochman; Matthew L Maciejewski; Evelyn Granieri; R Sean Morrison Journal: J Palliat Med Date: 2006-08 Impact factor: 2.947
Authors: Gabriel A Brooks; Thomas A Abrams; Jeffrey A Meyerhardt; Peter C Enzinger; Karen Sommer; Carole K Dalby; Hajime Uno; Joseph O Jacobson; Charles S Fuchs; Deborah Schrag Journal: J Clin Oncol Date: 2014-01-13 Impact factor: 44.544
Authors: Maria Yefimova; Rebecca A Aslakson; Lingyao Yang; Ariadna Garcia; Derek Boothroyd; Randall C Gale; Karleen Giannitrapani; Arden M Morris; Jason M Johanning; Scott Shreve; Melissa W Wachterman; Karl A Lorenz Journal: JAMA Surg Date: 2020-02-01 Impact factor: 14.766
Authors: Max R Coffey; Katelynn C Bachman; Stephanie G Worrell; Luis M Argote-Greene; Philip A Linden; Christopher W Towe Journal: J Surg Res Date: 2021-06-21 Impact factor: 2.192