Departments of Surgical Oncology, The University of Texas MD, Anderson Cancer Center, Houston, Texas.
Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer, Center, Houston, Texas.
Ann Surg. 2023 Feb 1;277(2):284-290. doi: 10.1097/SLA.0000000000004974. Epub 2023 Jan 10.
The aim of this study was to assess rates of palliative care (PC) involvement in the care of patients with malignant gastrointestinal obstruction (GIO) and its influence on interdisciplinary team involvement.
Malignant GIO is an advanced oncologic diagnosis with associated poor prognosis. Data regarding PC and interdisciplinary team involvement in these patients is lacking.
We identified consecutive surgical consultations for GIO in cancer patients at a single institution from August 2017 to July 2019. Clinical characteristics were collected. Rates of PC consultation, ACP discussion, code status change to do not resuscitate, and interdisciplinary service consultation were evaluated.
We identified 200 patients with consultations for GIO, of whom 114 (57%) had malignant GIO and were included in our study. Of these patients, 95 (83%) had stage IV disease; 68 (60%) had peritoneal metastasis, and 70 (61%) had other intra-abdominal recurrence or metastasis. PC consultation was obtained in 69 patients (61%). PC consultation was associated with higher rates of ACP discussion (64% vs 29%; P < 0.001), code status change to do not resuscitate (30% vs 2%; P < 0.001), nonsurgical procedure (46% vs 11%; P < 0.001), discharge to hospice (30% vs 7%; P < 0.001), and involvement of spiritual care (48% vs 22%; P = 0.01), social work (77% vs 42%, P < 0.001), psychology/psychiatry (42% vs 4%, P < 0.001), nutrition (86% vs 62%, P = 0.006), physical therapy (54% vs 31%, P = 0.02), and occupational therapy (42% vs 16%, P = 0.004).
PC consultation benefits patients with malignant GIO by facilitating comprehensive interdisciplinary care, ACP discussions, and transition to hospice care, where appropriate. Diagnosis of malignant GIO should be a trigger for PC consultation or, in facilities with limited PC resources, consideration of deliberately broad interdisciplinary consultation.
本研究旨在评估姑息治疗（PC）在恶性胃肠道梗阻（GIO）患者治疗中的参与率及其对多学科团队参与的影响。
恶性 GIO 是一种晚期肿瘤诊断，预后较差。关于这些患者的 PC 和多学科团队参与的数据尚缺乏。
我们在一家机构中确定了 2017 年 8 月至 2019 年 7 月期间连续的癌症患者 GIO 外科会诊。收集临床特征。评估 PC 咨询、ACP 讨论、复苏意愿变更为非复苏意愿以及多学科服务咨询的发生率。
我们共确定了 200 例 GIO 会诊患者，其中 114 例（57%）为恶性 GIO 患者，纳入本研究。这些患者中，95 例（83%）为 IV 期疾病；68 例（60%）有腹膜转移，70 例（61%）有其他腹腔内复发或转移。69 例（61%）患者获得了 PC 咨询。PC 咨询与更高的 ACP 讨论率（64%比 29%；P < 0.001）、复苏意愿变更为非复苏意愿（30%比 2%；P < 0.001）、非手术治疗（46%比 11%；P < 0.001）、临终关怀出院（30%比 7%；P < 0.001）、精神关怀（48%比 22%；P = 0.01）、社会服务（77%比 42%，P < 0.001）、心理/精神病学（42%比 4%，P < 0.001）、营养（86%比 62%，P = 0.006）、物理治疗（54%比 31%，P = 0.02）和职业治疗（42%比 16%，P = 0.004）相关。
PC 咨询通过促进全面的多学科护理、ACP 讨论以及在适当情况下向临终关怀过渡，使恶性 GIO 患者受益。恶性 GIO 的诊断应触发 PC 咨询，或者在 PC 资源有限的机构中，应考虑进行广泛的多学科咨询。
