Increased in-hospital mortality and emergent cases in patients with stage IV cancer
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ORIGINAL ARTICLE
Increased in-hospital mortality and emergent cases in patients with stage IV cancer Elleana J. Majdinasab 1 & Yana Puckett 2 & Kevin Y. Pei 3 Received: 25 July 2020 / Accepted: 15 October 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background Cancer patients in the USA are still being treated with aggressive, life-prolonging interventions. Palliative care services remain vastly underutilized despite surges in both quality and quantity of programs. We evaluated surgical outcomes of metastatic cancer patients to question whether palliative care may be a better option. Study design We queried the 2014 National Surgical Quality Improvement Program database (NSQIP) for patients with a diagnosis of malignancy (ICD 9 Codes 145.00 to 200.00). Cases were divided into metastatic and non-metastatic cancer. Demographic data including preoperative, intraoperative, and postoperative factors, as well as complications and comorbidities were compared between these two groups. Independent t testing was used to compare continuous variables. Chi-square testing was used to compare categorical variables. Multiple logistic regression was used to assess for predictors of mortality in metastatic cancer. Results A total of 80,275 cancer patients were analyzed, 11.8% (9423) of whom had metastatic disease. In-hospital mortality rate was found to be 4 times higher among patients with metastatic cancer (2.1% vs. 0.5%; P = < 0.0001). Of those metastatic cancer patients that died while in hospital, 18.5% had an emergency surgery performed. After adjusting for confounders, dyspnea at rest/ moderate exertion (OR 5.7/2.4; 95% CI 2.7/1.6 to 11.9/3.7; P < 0.0001) was found to be the most significant predictor of in hospital mortality in stage IV cancer patients. Conclusion Aggressive treatment in advanced cancer patients contributes to alarmingly high in-hospital mortality. Improved, deliberate communication of palliative care options with patients is exceedingly conducive to enhancing end-of-life cancer care. Keywords Metastatic cancer . In hospital mortality . Surgical outcomes . Hospice . Palliative care . End of life care
Introduction Many stage IV cancer patients in the USA are still being treated immediately with aggressive, life-prolonging interventions. Despite a newfound appreciation for delivering excellent end of life care to terminally ill patients, cancer treatment is becoming increasingly more aggressive and extensive, often lasting to the very end of patients’ lives [6]. * Yana Puckett [email protected] 1
School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
2
Department of Surgery, West Virgina University School of Medicine, 3200 MacCorkle Ave SE,, Charleston, WV 25304, USA
3
Department of Acute Care Surgery and Surgical Critical Care, Houston Methodist, Houston, TX, USA
Hospice and palliative care services have grown steeply in both number and quality over the years, yet enough Americans are not utilizing such programs to enhance and shape their
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