title: Indicators of symptom improvement and survival in inpatients with advanced cancer undergoing palliative surgical consultation.
abstract: BACKGROUND
  The purpose of this study was to prospectively identify the presentation, treatment, and outcomes of inpatients with advanced malignancy undergoing palliative surgical consultation.
  
  
  METHODS
  Inpatients undergoing palliative surgical consultation were prospectively identified from November 2008 to May 2011. Medical records were retrospectively reviewed to obtain clinical data and outcome.
  
  
  RESULTS
  Of 202 consultations, the diagnoses were wound problems (N = 39, 19%), bowel obstruction (N = 75, 37%), intra-abdominal inflammatory conditions (N = 36, 18%), abdominal pain of unclear etiology (N = 13, 6%), gastrointestinal hemorrhage (N = 15, 7%), malnutrition/feeding tube request (N = 14, 7%), and biliary obstruction (N = 10, 5%). Management included non-operative/non-procedural treatment in 81 (40%), procedures in 35 (17%), and surgery in 86 (43%). Patients treated with non-operative/non-procedural, procedural, and surgical treatment demonstrated symptom improvement rates of 60% (49/81), 69% (24/35), and 78% (67/86), respectively. Surgical treatment was associated with symptom improvement (OR 2.3 [95% CI 1.2-4.5]) compared to non-operative/non-procedural management. Symptom improvement was associated with improved survival (HR 0.27 [95% CI 0.19-0.38]) on multivariate analysis.
  
  
  CONCLUSIONS
  Symptom improvement was obtained in the majority of patients regardless of treatment strategy. Although patients selected for surgery demonstrated an association with symptom improvement, future prospective studies are needed to determine additional variables important in treatment selection.
authors.affiliation: Department of Surgery, The University of Arkansas for Medical Sciences, Little Rock, AR, USA. badgwell@uams.edu
authors.forename: Brian D
authors.initials: BD
authors.lastname: Badgwell
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Aloia
authors.forename: John
authors.initials: J
authors.lastname: Garrett
authors.forename: Gabe
authors.initials: G
authors.lastname: Chedister
authors.forename: Tom
authors.initials: T
authors.lastname: Miner
authors.forename: Robert
authors.initials: R
authors.lastname: Krouse
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D009369:Neoplasms / Q000150:complications / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D016017:Odds Ratio; D010166:Palliative Care / Q000379:methods*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012017:Referral and Consultation; D012189:Retrospective Studies; D063189:Symptom Assessment; D016896:Treatment Outcome