In a study published by Gauvin et al in JNCCN–Journal of the National Comprehensive Cancer Network, researchers examined over 200 patients with gastrostomy tubes and highlighted the need for a multidisciplinary approach to palliative care decision-making for patients with cancer.
A gastrostomy tube is a device that is inserted through the abdominal wall and into the stomach to either deliver fluid and nutrition directly into the stomach or for decompression in the setting of a bowel obstruction in the palliative setting.
“We really wanted to look at our experience as a cancer center with these tubes. What this study really highlighted was that, overall, we need to do a better job with palliative care and end-of-life decision-making with patients,” said lead study author Jeffrey M. Farma, MD, FACS, Chief of the Division of General Surgery and Professor in the Department of Surgical Oncology at Fox Chase Cancer Center.
Study Findings
Dr. Farma worked on this study with medical students participating in the Temple University Lewis Katz School of Medicine Surgical Oncology Research Program at Fox Chase Cancer Center. Researchers examined clinical data from 242 patients with cancer who underwent a gastrostomy tube placement from January 2013 to December 2017. The average age of patients at diagnosis was 61 years.
They then looked at how many patients ended up getting consultations with either the palliative or supportive oncology team, nutrition consults, or social work consults. For those with decompressive tubes, 45.5% had a palliative care consult, 56.4% were seen by social workers, and 46.3% went to hospice.
“[Consults] really help to facilitate end-of-life decision-making,” Dr. Farma added. “A lot of patients were not having these consults, and we found that with a multidisciplinary team approach, patients were more likely to go home on hospice, which is an important decision at the end of a person’s cancer journey.” As Dr. Farma stated, the frequency of hospice discharge was higher in patients who had consults (53.7% vs 23.1%, P = .01).
Results of the study also demonstrated that half of the observed patients who received decompressive gastrostomy tubes were shown to have stage IV disease and died within 1 month of tube placement. Additionally, patients with tubes for nutrition saw no change in functionality, complication rate, or survival, regardless of chemotherapy status, the authors wrote.
“This was really a multidisciplinary study that highlighted some important points concerning patient care,” added Dr. Farma.
The study authors concluded, “Half of the patients who received decompressive gastrostomy tubes presented with stage IV disease and died within 1 month of placement. Those with more than one consult were more likely to be discharged to hospice. Patients with gastrostomy tubes for nutrition saw no change in functionality, complication rate, or survival, regardless of adjunct chemotherapy status. These findings illustrate the need for a tool to allow a better multidisciplinary approach and interventional decision-making for patients with cancer.”
Disclosure: For full disclosures of the study authors, visit jnccn.org.
