Prolonged Length of Stays, Readmissions, and Discharge to Care Facilities Among Postoperative Patients With Advanced Cancer

Key Points

  • The group of patients with stage IV cancer spent more time in the hospital (32% vs 20%), were readmitted to the hospital more frequently (16% vs 10%), were more often referred to another facility such as skilled nursing (16% vs 13%), and had higher mortality within 30 days of their procedures (8% vs 2.5%) than their counterparts who did not have late-stage cancers.
  • Stage IV cancer patients who didn’t have any complications during their hospitalization ended up staying in the hospital longer, were readmitted more often, were more often discharged to other facilities, and had higher 30-day mortality compared to patients who didn’t have stage IV cancer.

Patients with disseminated advanced cancer who undergo surgery are far more likely to endure long hospital stays and readmissions, referrals to extended care facilities, and death, University of California (UC) Davis researchers have found.

Their study, published by Bateni et al in PLOS One, highlights the dilemma physicians and surgeons face when their terminally ill cancer patients are diagnosed with conditions that may benefit from surgery, such as bowel obstruction, as well as the need for substantive discussions about the risks of surgery and implications on future quality of life.

“We commonly consult with patients who have acute surgical conditions and advanced cancer, and it has left us to weigh the risks and benefits of surgical intervention,” said lead author Sarah B. Bateni, MD, who is completing a research residency with the UC Davis Department of Surgery. “It’s important to carefully examine their risks before proposing surgery, and to understand their goals for their remaining days.”

Study Findings

For the study, Dr. Bateni and colleagues examined the cases of approximately 18,000 patients who had stage IV cancer and surgery. The cases were compared with patients who had similar characteristics such as age, gender, and functional status before surgery and underwent similar operations but who did not have stage IV cancer.

They found that the group of patients with stage IV cancer spent more time in the hospital (32% vs 20%), were readmitted to the hospital more frequently (16% vs 10%), were more often referred to another facility such as skilled nursing (16% vs 13%), and had higher mortality within 30 days of their procedures (8% vs 2.5%) than their counterparts who did not have late-stage cancers.

What was most surprising, Dr. Bateni said, was that stage IV cancer patients who didn’t have any complications during their hospitalization ended up staying in the hospital longer, were readmitted more often, were more often discharged to other facilities, and had higher 30-day mortality compared to patients who didn’t have stage IV cancer.

“Stage IV cancer really is an indicator of the frailty of these patients and is itself a risk factor for readmission, prolonged stays in the hospital, and discharge to other facilities,” she said.

Dr. Bateni and her coauthors concluded that doctors and surgeons need to talk with their terminally ill cancer patients about their end-of-life goals, palliative care, and the risks and benefits of surgery.

“We all need to clarify the goals of care for patients with advanced cancer prior to providing—or even discussing—the potential surgical interventions,” she said.

Given that the prevailing wisdom has been that surgery is the only treatment option for these patients, the researchers now plan to analyze the outcomes of stage IV cancer patients with conditions that are considered operable but who don’t have surgery.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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