Surgical Treatment Intensity at the End of Life in Cancer Patients
Author Information
Author(s): Lawday Samuel BMBS, MByRes, Zucker Benjamin E. MA, MBBS, MRCS, Gardner Shona MBChB, MRCS, Robb James MBChB, MA, Leandro Lorna MA, BM, BCh, Hollingworth William PhD, Blazeby Jane MBChB, MD, McNair Angus G.K. PhD, FRCS, Chamberlain Charlotte PhD, MRCP
Primary Institution: NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
Hypothesis
What is the intensity of surgical treatment received by cancer patients at the end of life?
Conclusion
A significant number of cancer patients undergo invasive procedures at the end of life, but there is considerable variation in reporting and practice.
Supporting Evidence
- Up to 79% of patients underwent invasive procedures in the last month of life.
- High-quality research in surgical care at the end of life is lacking.
- Patients who are younger and have higher household incomes tend to receive more aggressive treatment.
- Geographical variation affects treatment intensity at the end of life.
- Palliative care referrals are linked to reduced treatment intensity.
- Healthcare costs in the last year of life can be significantly higher than in other years.
- Significant reporting heterogeneity exists in the literature regarding surgical care at the end of life.
- Identification of inappropriate surgical treatment intensity at the end of life is currently not possible.
Takeaway
Many cancer patients have surgeries in their last days, but it's unclear if these surgeries help them or just add to their suffering.
Methodology
This systematic review followed PRISMA guidelines and included observational studies on surgical intensity at the end of life in adult cancer patients.
Potential Biases
High or moderate risk of bias was identified in 23 studies due to unrepresentative samples and retrospective data.
Limitations
There is significant heterogeneity in reporting practices and inclusion criteria across studies, making it difficult to draw firm conclusions.
Participant Demographics
The studies included a range of cancer types and demographics, with a median sample size of 8814 participants.
Digital Object Identifier (DOI)
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