UC Davis researchers are urging end-of- life patients to discuss their conditions prior to consenting to surgery. Those who have advanced cancer and undergo surgery are far more likely to endure long hospital stays and readmissions, referrals to extended care facilities and death.
A study that was published in PLOS One highlights the dilemma that surgeons and physicians face when they have a terminally ill cancer patient that has been diagnosed with the conditions that may benefit from surgery, and have the need for substantive discussions about the risks of surgery and implications on future quality of life. Even though the physicians consult with these patients for acute surgical conditions and advanced cancer, it leaves them to weigh the risks and benefits of surgical intervention. It’s very important to really examine the patient’s risks before surgery is proposed, and to completely understand their goals and wishes for their remaining days.
A study conducted by author Sara B. Bateni examined the cases of about 18,000 patients with stage 4 cancers and the option of surgery. The cases were then compared with other patients who had similar characteristics such as age, gender and functional status before surgery, and had undergone similar operations but did not have stage 4 cancer. The patients with stage 4 cancer spent more time in the hospital, were readmitted to the hospital more frequently, were more often referred to another facility, such a skilled nursing unit, and had higher mortality within 30 days of their procedures than their counterparts, who did not have late-stage cancer.
Choosing a more comfortable end-of- life stage, to me, would be achieving less pain and able to enjoy family and friends until the Lord chose to take me home. To me, surgery at this late stage would only cause more stress and pain to the patient as well as the family, and who wants to spend that time in the hospital rather than a comfortable place?
In conclusion of the study, Bateni and her co-authors suggested that surgeons should to talk with their terminally ill cancer patients about their end-of- life goals, palliative care and the risks and benefits of surgery. There are definite potential surgical interventions. Their plan now is to analyze the outcomes of stage 4 cancer patients with conditions that are considered operable, but who choose not to have surgery. After having been the support person for a woman with pancreatic cancer undergoing chemo treatments, my decision for treatment would be entirely different if I were to be diagnosed with any stage 4 cancers. What about the alternative of building the body and immune system before making any chemo or surgery decisions?
Everyone must choose his or her own decisions regarding treatment when faced with any type of stage 4 cancer. No two people are going to have the same goals, so if you or a loved one is faced with this decision, be sure to investigate all options and choose accordingly. These decisions are critical, and never easy on the patient, friends or family.
–Dr Fredda Branyon