Resource utilization by palliative surgery patients: results of the decision and outcomes in palliative surgery (DOPS) trial

Abstract

18543 Background: The number of cancer patients is increasing. Though many cancer treatments are successful at improving survival, most tumors recur and become incurable. A spectrum of symptoms then manifest, many requiring operations. As this happens and the focus becomes symptom management, health system resources used often differ from other scenarios. This study seeks to define the type and breadth of perioperative resource utilization after palliative operations. Methods: Prospectively, patients with advanced malignancies getting palliative operations were followed 3 months postoperatively. In addition to demographics, all encounters with any medical personnel and healthcare resources used were captured by a thorough chart audit and entered into a database. Results: Of the 106 patients entering the study, 67 remained after 3 months. Patients suffered from a mean of 2 symptoms, pain being most common. Patients had a mean of 25.4 encounters (range 1–94). Most commonly, the encounters were with the departments of surgery, medical oncology, and radiation oncology. Half of the encounters were with physicians while 47% were with physician extenders and 3% with supportive staff. Eighty-seven percent of encounters were scheduled. Half occurred in the clinics, 21% in urgent care, and 29% by phone. Fifteen patients were readmitted, most often for symptom management (52%). The 54 patients receiving supportive care referrals had a mean of 2 different referrals per patient and were primarily social work, nutrition, and rehabilitation. Two pain management referrals were initiated. Conclusions: Patients undergoing palliative operations use no more resources than those having curative procedures. Because of disease persistence, the types of resources used differ. Defining these differences is important as health systems plan for the increase in aged with incurable cancers. Early referral to supportive care specialists, vital as symptoms worsen, remains underutilized. Without inclusion of these professions, patient quality of life and distress are not being helped as much as possible. Medical and surgical oncologists should aggressively assess and manage symptoms and consult colleagues to comprehensive symptom management. No significant financial relationships to disclose.