title: Surgical palliation of advanced gastrointestinal tumors.
abstract: Patients with advanced gastrointestinal tumors suffer a spectrum of progressive symptoms that reduce their quality of life (QOL). Operative palliative strategies seeking to improve QOL and decrease symptom burden are poorly studied. This study seeks to measure the effect of operations on symptoms and QOL in patients with advanced gastrointestinal malignancies. Patients undergoing World Health Organization (WHO)-defined palliative operations for gastrointestinal cancers were prospectively followed with monthly QOL and Distress Thermometer surveys until 6 months post-operatively. Comparisons were made between preoperative and 3-month postoperative data. Parameters of physical, psychological, social, and spiritual QOL were measured on a scale of 0 (worst) to 5 (best). Frequency of occurrence and degree of distress caused by that specific symptom were scored from 0 (rarely/not at all) to 5 (most of the time/severely). Thirty-five patients had gastrointestinal cancer. The median age was 55.3 years. The most common symptoms were pain and obstruction. Thirty-three operations were abdominal. Ultimately, 34 patients (97%) were discharged home. When preoperative data were compared to 3 months postoperative, the frequency of the primary symptom improved by 2.22 (p = 0.001) and the distress it caused decreased by 1.82 (p = 0.004). Physical QOL decreased by 0.61 (p = 0.009), psychological QOL decreased by 0.50 (p = 0.015), social QOL decreased by 0.48 (p = 0.017), spiritual QOL decreased by 0.42 (p = 0.008), and overall QOL decreased by 0.50 (p = 0.012). Because of the unrelenting nature of gastrointestinal tumors, QOL over time will inevitably decrease. Palliative operations effectively improve symptom frequency and distress without greatly affecting the expected decline in QOL and its parameters.
authors.affiliation: Department of Surgery, Duke University, Raleigh, North Carolina, USA.
authors.forename: Yale D
authors.initials: YD
authors.lastname: Podnos
authors.forename: Gloria
authors.initials: G
authors.lastname: Juarez
authors.forename: Collette
authors.initials: C
authors.lastname: Pameijer
authors.forename: Gwen
authors.initials: G
authors.lastname: Uman
authors.forename: Betty R
authors.initials: BR
authors.lastname: Ferrell
authors.forename: Lawrence D
authors.initials: LD
authors.lastname: Wagman
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000145:classification / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D011446:Prospective Studies; D011788:Quality of Life; D014481:United States