Minimally invasive palliative procedures in oncology: a review of a multidisciplinary collaboration.

Abstract

Minimally invasive palliative procedures (MIPPs) are sometimes considered step 4 of the World Health Organization's three-step ladder. A case conference has been created at the BC Cancer Agency to facilitate access to MIPPs for advanced cancer patients with severe pain not responding to conventional analgesics. The twice monthly conference discusses referrals for pain control procedures and reviews imaging, with palliative care, musculoskeletal interventional radiology, radiation oncology, medical oncology, and anesthesia experts in attendance. The aims of this study are: first, to determine the benefit to patients from the procedures recommended by the case conference, and second, to explore the impact of the case conference on clinical decision-making. A retrospective review of electronic charts of all cancer patients referred to the MIPP case conference between December 20, 2011 and June 25, 2013. There were 103 referrals, resulting in 69 procedures performed among 63 patients. Over 80 % of procedures provided analgesic benefit. Pain scores fell across all categories post-procedure. Mean worst pain scores fell from 8.1 ± 1.4 to 4.6 ± 2.8 (P < 0.001). Patient function, mobility, and symptoms measured by the Edmonton Symptom Assessment System also improved post-procedure. At time of abstract submission, 37/63 (58.7 %) patients had died, and the mean survival post-procedure was 200 days. The documented rate of major adverse events attributable to MIPPs was 2/69 (2.9 %). MIPPs are valuable treatment options in patients with severe cancer pain despite use of appropriate step 3 WHO ladder medications. The case conference facilitates excellent communication and sharing of expertise, ensuring optimal patient care.