Frequent and early death limits quality of life assessment in patients with advanced malignancies evaluated for palliative surgical intervention.
BACKGROUND
The purpose of this study was to determine the feasibility and optimal timing of quality of life assessment for patients undergoing palliative surgical evaluation.


METHODS
Patients with an advanced malignancy undergoing consultation for palliative surgical intervention were prospectively enrolled from November 2009 to January 2011. Follow-up quality of life assessment was performed using validated instruments at 1 and 3 months post-enrollment. Univariate analysis of variables was performed to identify clinicopathologic variables associated with questionnaire completion.


RESULTS
Of 77 patients enrolled, the most common clinical presentations included bowel obstruction (32 %), abdominal pain (21 %), wound complications (18 %), and gastrointestinal bleeding (11 %). Of the 77 patients, 34 (44 %) were treated with nonoperative/nonprocedural care, 9 (12 %) with endoscopic or interventional radiologic procedures, and 34 (44 %) with surgery. Follow-up questionnaires were obtained at 1 month and 3 months in 48 % and 15 %, respectively. A total of 31 patients (40 %) died prior to study completion. On univariate analysis, death was the only factor associated with questionnaire response. All other demographic, clinical, and treatment variables were not associated with response to questionnaires. There were no significant differences in baseline or follow-up quality of life scores between patients treated with surgical intervention or nonoperative management.


CONCLUSIONS
Death during the study period was a significant factor in limiting adequate follow-up assessment. Future studies attempting to obtain follow-up data on patients evaluated for palliative surgical intervention may require larger patient numbers to account for frequent early death in this population and anticipate the need to account for the high rate of missing data in statistical analysis.
Department of Surgical Oncology, The University of Arkansas for Medical Sciences, Little Rock, AR, USA. badgwell@uams.edu
Brian
B
Badgwell
Robert
R
Krouse
Janice
J
Cormier
Caesar
C
Guevara
V Suzanne
VS
Klimberg
Betty
B
Ferrell
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality / Q000601:surgery*; D010166:Palliative Care; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D011795:Surveys and Questionnaires; D015996:Survival Rate; D055815:Young Adult