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Was it worth it? : critical evaluation of a novel outcome measure in oncologic palliative surgery
Article indépendant
Background: Patient selection for palliative surgery is complex and appropriate outcome measures are incompletely defined. We explored the usefulness of a specific outcome measure "was it worth it" in patients following palliative intent operations for advanced malignancy.
Study design: Retrospective review of a comprehensive longitudinal palliative surgery database at an academic tertiary-care center. All patients who underwent palliative-intent operations for advanced cancer from 2003 to 2022. Patient satisfaction ("was it worth it") reported within 30 days of operation following palliative-intent surgery.
Results: 180 patients were identified. 81.7% self-reported their palliative surgery was "worth it" (WI). Patients who reported their surgery was "not worth it" (NWI) were significantly older, more likely to have recurrent symptoms and to need re-operation. There was no significant difference in overall, recurrence-free, and re-operation-free survival for patients when comparing WI to NWI. Initial symptom improvement was not significantly different between groups. Age over 65 (HR 0.25, 95% CI 0.07-0.80, p=0.03), family engagement (HR 6.71, 95% CI 1.49-31.8, p=0.01), and need for re-operation (HR 0.042, 95% CI 0.01-0.16, p<0.0001) were all independently associated with patients reporting their surgery was WI.
Conclusions: Here we demonstrate that simply asking a patient "was it worth it" following a palliative intent operation identifies a distinct cohort of patients that traditional outcome measures fail to distinguish. Family engagement and durability of an intervention are critical factors in determining patient satisfaction following palliative intervention. These data highlight the need for highly individualized care with special attention paid to patients self-reporting their operation was NWI.
http://dx.doi.org/10.1097/XCS.0000000000000649
Voir la revue «Journal of the American College of Surgeons»
Autres numéros de la revue «Journal of the American College of Surgeons»
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