Frequent and Early Death Limits Quality of Life Assessment in Patients with Advanced Malignancies Evaluated for Palliative Surgical Intervention

Abstract

The purpose of this study was to determine the feasibility and optimal timing of quality of life assessment for patients undergoing palliative surgical evaluation. Patients with an advanced malignancy undergoing consultation for palliative surgical intervention were prospectively enrolled from November 2009 to January 2011. Follow-up quality of life assessment was performed using validated instruments at 1 and 3months post-enrollment. Univariate analysis of variables was performed to identify clinicopathologic variables associated with questionnaire completion. Of 77 patients enrolled, the most common clinical presentations included bowel obstruction (32%), abdominal pain (21%), wound complications (18%), and gastrointestinal bleeding (11%). Of the 77 patients, 34 (44%) were treated with nonoperative/nonprocedural care, 9 (12%) with endoscopic or interventional radiologic procedures, and 34 (44%) with surgery. Follow-up questionnaires were obtained at 1month and 3months in 48% and 15%, respectively. A total of 31 patients (40%) died prior to study completion. On univariate analysis, death was the only factor associated with questionnaire response. All other demographic, clinical, and treatment variables were not associated with response to questionnaires. There were no significant differences in baseline or follow-up quality of life scores between patients treated with surgical intervention or nonoperative management. Death during the study period was a significant factor in limiting adequate follow-up assessment. Future studies attempting to obtain follow-up data on patients evaluated for palliative surgical intervention may require larger patient numbers to account for frequent early death in this population and anticipate the need to account for the high rate of missing data in statistical analysis.