Congress Abstracts 2003

43

A PROSPECTIVE EVALUATION OF PALLIATIVE OUTCOMES OF SURGERY FOR ADVANCED MALIGNANCIES. Betty Ferrell, PhD, FAAN, David Smith, PhD, Tami Borneman, RN, MSN, Laurence McCahill, MD, David Chu, MD, and Gloria Juarez, RN, MSN, PhDc, City of Hope National Medical Center, Duarte, CA.

Surgery for malignant disease has focused on patient survival with less focus on the role of surgery in improved quality of life (QOL). Palliative surgery can improve QOL by relieving symptoms related to advanced malignancy. The purpose of this study was to evaluate patient outcomes following surgery. The QOL framework (Ferrell & Grant) and a clinical decision-making model served as the study theoretical framework. The sample included 59 patients who required a major operation and had advanced malignancy. Methods included medical record review and symptom assessment performed pre-operatively and at 2, 6, and 12 weeks postoperatively utilizing the Memorial Symptom Assessment Scale (MSAS) and the City of Hope QOL instrument. Data were analyzed using descriptive statistics and repeated measures analysis. Findings indicate that surgical indications were resection of recurrent disease (n = 28, 47%), metastasectomy (n = 17, 28%), or initial resection (n = 14, 24%) for gastrointestinal malignancy (n = 28, 47%), sarcoma (n = 16, 27%), and other (n = 15, 25%). The mean age was 58.5 years, M:F 28:31, hospital stay was 8.5 days (2–24), and 30-day mortality was 3/59 (5%). Six-month survival was 62%. Symptoms intended to treat among 33 symptomatic patients were pain (27/33, 82%), heaviness/pressure (7), tumor discharge/malodor (6), nausea/vomiting (6), and bleeding (4), with 20/33 (61%) reporting multiple severe symptoms. Other moderate to severe symptoms (= 2 on a 1–4 MSAS scale, 4 = very severe) reported were lethargy (46%), worrying (32%), lack of appetite (30%), difficulty sleeping (28%), nervousness (26%), and feeling sad (25%). While global QOL indices were unchanged at 3 months compared to baseline (MSAS -1.1, p = 0.3, QOL + 0.04, p = 0.97), symptom improvement for patients with symptom severity scores > 2 on MSAS scale were documented for pain (-1.17, p = .001), itching (-2.61, p = .001), vomiting (-2.14, p = .02), and lack of appetite (-1.55, p = .01). Findings suggest that symptomatic patients undergoing surgery for advanced malignancies can attain symptom relief. QOL outcomes can guide clinical decision making and study findings suggests that surgery is an important component of palliative care. Advanced understanding of the needs of patients undergoing palliative surgery and its impact on QOL is an important aspect of cancer care.