title: Palliative care for patients with gastrointestinal cancer dying under surgical care: a case for acute palliative care units?
abstract: OBJECTIVE
  Patients with advanced gastrointestinal cancer may present late to hospital services and die under surgical care. The aim of this study was to examine end of life care in patients dying of gastrointestinal cancer in Scottish hospital surgical wards.
  
  
  METHODS
  The Scottish Audit of Surgical Mortality prospectively peer reviews all inpatient deaths under the care of a consultant surgeon. Patients who died with gastrointestinal cancer under surgical care from 1994 to 2006 were evaluated for operative interventions, adverse events, and palliative care provision. Data was compared with inpatient data from the Information Statistics Division of NHS Scotland.
  
  
  RESULTS
  A total of 8019 patients died with gastrointestinal cancer on a surgical ward over 12 years. For 4350 (54%), no operation or endoscopy was performed during the final admission and adverse events were identified in only 86 (2%) of these patients, most commonly due to a complication of an interventional procedures. Specialist palliative care was provided to 57% of patients and was not influenced by cancer site.
  
  
  CONCLUSIONS
  A substantial proportion of patients die with gastrointestinal cancer on general surgical wards without operative or endoscopic intervention and may receive better end of life care in an acute palliative care setting.
authors.affiliation: Dundee Cancer Centre, Ninewells Hospital and Medical School, Dundee DD1 9SY, United Kingdom. jamie.young@nhs.net
authors.forename: J A
authors.initials: JA
authors.lastname: Young
authors.forename: L
authors.initials: L
authors.lastname: Waugh
authors.forename: G
authors.initials: G
authors.lastname: McPhillips
authors.forename: P
authors.initials: P
authors.lastname: Levack
authors.forename: A M
authors.initials: AM
authors.lastname: Thompson
mesh_terms: D013505:Digestive System Surgical Procedures / Q000706:statistics & numerical data*; D005770:Gastrointestinal Neoplasms / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D008485:Medical Audit; D020380:Needs Assessment; D010166:Palliative Care / Q000458:organization & administration / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012606:Scotland; D013503:Surgery Department, Hospital / Q000706:statistics & numerical data*; D013727:Terminal Care / Q000379:methods* / Q000458:organization & administration / Q000706:statistics & numerical data