Outcome measures other than morbidity and mortality for patients with incurable cancer and gastrointestinal obstruction

Brian Badgwell, Robert Krouse, Vicki Klimberg, Eduardo Bruera

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Objective: To prospectively evaluate outcome measures of patients undergoing palliative surgical evaluation for gastrointestinal obstruction. Methods: Patients with an incurable malignancy undergoing consultation for gastrointestinal obstruction were prospectively enrolled from November 2009 to July 2012. We evaluated two patient-reported outcome measures of quality of life (Functional Assessment of Cancer Therapy-General [FACT-G]) and treatment satisfaction (Functional Assessment of Chronic Illness Therapy-Treatment Satisfaction-General Version 1 [FACIT-TS-G]) and five observational outcome measures (symptom improvement, 30 "good days," ability to tolerate diet at discharge, discharge home, and death within 90 days). Results: Of 53 patients enrolled, 13 had gastric outlet obstruction, 22 had small bowel obstruction, and 18 had large bowel obstruction. Patient-reported measures could not be analyzed because only 19 patients (36%) completed the FACT-G and FACIT-TS-G survey at 1-month follow-up. However, we were able to obtain results for the 5 clinical observational outcomes in all patients. Symptom improvement was obtained in 41 (77%) patients, 30 "good days" in 40 (75%), ability to tolerate diet at discharge in 45 (85%), discharge to home in 46 (87%), and 18 (34%) of patients died within 90 days of evaluation. Large bowel obstruction was associated with symptom improvement, and noncolorectal cancer histology and carcinomatosis were negatively associated with having 30 "good days." The ability to tolerate oral intake at discharge was associated with Eastern Cooperative Oncology Group performance status and no recent chemotherapy administration. Death within 90 days was independently associated with noncolorectal cancer histology, ascites, and nonsurgical treatment. Conclusions: Observational outcome measures can provide follow-up data and the identification of variables associated with outcome for patients who are unable to respond to outpatient surveys.

Original languageEnglish (US)
Pages (from-to)18-26
Number of pages9
JournalJournal of Palliative Medicine
Volume17
Issue number1
DOIs
StatePublished - 2014
Externally publishedYes

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Gastrointestinal Neoplasms
Outcome Assessment (Health Care)
Morbidity
Mortality
Aptitude
Therapeutics
Neoplasms
Histology
Chronic Disease
Gastric Outlet Obstruction
Diet
Ascites
Outpatients
Referral and Consultation
Quality of Life
Carcinoma
Drug Therapy

ASJC Scopus subject areas

  • Medicine(all)
  • Anesthesiology and Pain Medicine
  • Nursing(all)

Cite this

Outcome measures other than morbidity and mortality for patients with incurable cancer and gastrointestinal obstruction. / Badgwell, Brian; Krouse, Robert; Klimberg, Vicki; Bruera, Eduardo.

In: Journal of Palliative Medicine, Vol. 17, No. 1, 2014, p. 18-26.

Research output: Contribution to journalArticle

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abstract = "Objective: To prospectively evaluate outcome measures of patients undergoing palliative surgical evaluation for gastrointestinal obstruction. Methods: Patients with an incurable malignancy undergoing consultation for gastrointestinal obstruction were prospectively enrolled from November 2009 to July 2012. We evaluated two patient-reported outcome measures of quality of life (Functional Assessment of Cancer Therapy-General [FACT-G]) and treatment satisfaction (Functional Assessment of Chronic Illness Therapy-Treatment Satisfaction-General Version 1 [FACIT-TS-G]) and five observational outcome measures (symptom improvement, 30 {"}good days,{"} ability to tolerate diet at discharge, discharge home, and death within 90 days). Results: Of 53 patients enrolled, 13 had gastric outlet obstruction, 22 had small bowel obstruction, and 18 had large bowel obstruction. Patient-reported measures could not be analyzed because only 19 patients (36{\%}) completed the FACT-G and FACIT-TS-G survey at 1-month follow-up. However, we were able to obtain results for the 5 clinical observational outcomes in all patients. Symptom improvement was obtained in 41 (77{\%}) patients, 30 {"}good days{"} in 40 (75{\%}), ability to tolerate diet at discharge in 45 (85{\%}), discharge to home in 46 (87{\%}), and 18 (34{\%}) of patients died within 90 days of evaluation. Large bowel obstruction was associated with symptom improvement, and noncolorectal cancer histology and carcinomatosis were negatively associated with having 30 {"}good days.{"} The ability to tolerate oral intake at discharge was associated with Eastern Cooperative Oncology Group performance status and no recent chemotherapy administration. Death within 90 days was independently associated with noncolorectal cancer histology, ascites, and nonsurgical treatment. Conclusions: Observational outcome measures can provide follow-up data and the identification of variables associated with outcome for patients who are unable to respond to outpatient surveys.",
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