Cloyd Jordan M, Khatri Rakhsha, Sarna Angela, Stevens Lena, Heh Victor, Dillhoff Mary, Kim Alex, Pawlik Timothy M, Ejaz Aslam, Wells-Di Gregorio Sharla, Scott Erin, Kale Sachin S
From the Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH.
Department of Surgery, UT Southwestern Medical Center, Dallas, TX.
Ann Surg Open. 2024 Nov 18;5(4):e520. doi: 10.1097/AS9.0000000000000520. eCollection 2024 Dec.
Although resection is generally necessary for curative-intent treatment of most solid organ cancers, surgery is occasionally aborted due to intraoperative findings. Following aborted cancer surgery, patients have unique care needs that specialized palliative care (PC) providers may be best equipped to manage. We hypothesized that early ambulatory PC referral following aborted cancer surgery would be feasible and acceptable.
This single-institution prospective clinical trial enrolled adult patients with gastrointestinal or hepatopancreatobiliary cancer with no prior PC exposure who had curative-intent oncologic surgery that was unexpectedly aborted. The primary endpoint was the completion of an ambulatory PC consultation within 30 days of enrollment. Secondary outcomes included changes in standardized measures of quality-of-life (QOL) and anxiety/depression during the 3-month follow-up.
Among 25 enrolled participants, the mean age was 65.3 ± 9.9 years, 68% were male, and 88% were White. The most common types of cancers were pancreatic (44%), hepatobiliary (20%), and colorectal (12%); reasons for aborting surgery were occult metastatic disease (52%) and local unresectability (36%). Only 13 of 25 (52%) met the primary endpoint of ambulatory PC within 30 days, less than the prespecified threshold of 70%. Overall, 16 (64%) patients completed ambulatory PC consultation a mean of 29.2 ± 15.8 days after enrollment. Of the 9 (36%) who did not, reasons included patient preference (n = 4), withdrawal from study (n = 1), lost to follow-up (n = 1), scheduling conflict (n = 1), and required inpatient PC before discharge (n = 2). Anxiety (4.94 ± 3.56 vs 3.35 ± 2.60, = 0.06), depression (4.18 ± 4.02 vs 4.76 ± 3.44, = 0.49), and QOL (82.44 ± 11.41 vs 82.03 ± 15.37, = 0.92) scores did not significantly differ at 3-month follow-up compared to baseline.
Barriers to early ambulatory palliative care consultation exist after aborted cancer surgery. Given the unique and complex care needs of this patient population, additional research is needed to optimize supportive care strategies.
尽管对于大多数实体器官癌症的根治性治疗而言，切除手术通常是必要的，但手术有时会因术中发现而中止。在癌症手术中止后，患者有独特的护理需求，专业的姑息治疗（PC）提供者可能最有能力进行管理。我们假设癌症手术中止后早期门诊PC转诊是可行且可接受的。
这项单机构前瞻性临床试验纳入了成年胃肠道或肝胆胰癌症患者，这些患者之前未接受过PC治疗，原本进行根治性肿瘤手术，但意外中止。主要终点是在入组后30天内完成门诊PC会诊。次要结局包括3个月随访期间生活质量（QOL）和焦虑/抑郁标准化测量指标的变化。
在25名入组参与者中，平均年龄为65.3±9.9岁，68%为男性，88%为白人。最常见的癌症类型是胰腺癌（44%）、肝胆癌（20%）和结直肠癌（12%）；手术中止的原因是隐匿性转移疾病（52%）和局部无法切除（36%）。25名患者中只有13名（52%）在30天内达到了门诊PC的主要终点，低于预先设定的70%的阈值。总体而言，16名（64%）患者在入组后平均29.2±15.8天完成了门诊PC会诊。在未完成的9名（36%）患者中，原因包括患者偏好（n = 4）、退出研究（n = 1）、失访（n = 1）、日程冲突（n = 1）以及出院前需要住院PC治疗（n = 2）。与基线相比，3个月随访时焦虑（4.94±3.56对3.35±2.60，P = 0.06）、抑郁（4.18±4.02对4.76±3.44，P = 0.49）和QOL（82.44±11.41对82.03±15.37，P = 0.92）评分无显著差异。
癌症手术中止后存在早期门诊姑息治疗会诊的障碍。鉴于该患者群体独特而复杂的护理需求，需要进一步研究以优化支持性护理策略。
