Palliative care training helps doctors steer cancer patients away from major surgery

Last Updated: 2018-05-22

By Carolyn Crist

(Reuters Health) - Doctors who don't have palliative care training are more likely to recommend aggressive surgery for patients with life-limiting diseases, a study suggests.

Researchers surveyed 102 surgeons, oncologists, intensivists, and palliative care doctors near Sacramento, California, asking how they would respond to four different surgical scenarios in patients with very advanced cancers.

In general, there wasn't much consensus on the treatment decisions, regardless of the doctors' specialties.

But overall, regardless of doctors' age, years of experience or medical specialty, those with less than 40 hours of palliative care training were more likely to recommend major operations as opposed to less aggressive procedures, the study team reported online April 27 in Surgery.

In one scenario, someone with advanced colon cancer had a bowel obstruction. In another, someone with advanced breast cancer had been injured in a car accident. The other two scenarios involved a patient with late-stage lung cancer and recurrent gastrointestinal bleeding and a patient with advanced prostate cancer and an inguinal hernia.

Surgeons in particular reported fewer hours of palliative care training during residency, fellowship and continuing medical education; one in five surgeons reported no experience with palliative care training at all, the authors found.

"We've seen a significant proportion of patients who go to the emergency room or intensive care unit with terminal malignancy die in the ICU," said study coauthor Dr. Richard Bold of the University of California, Davis Comprehensive Cancer Center in Sacramento.

"As cancer becomes a leading cause of death among aging Americans, we're all going to have to deal with these questions, from family to primary care doctors to specialists," Bold told Reuters Health by phone.

"It is important to remember that anyone facing a life-threatening diagnosis should be eligible for palliative care," said Dr. Mustafa Raoof of the City of Hope Cancer Center in Duarte, California, who wasn't involved with this study.

Raoof and colleagues have implemented a Surgical Palliative Care Immersion Training program for junior surgeons, based on the American College of Surgeon's "Surgical Palliative Care: A Resident's Guide" framework.

"Many in the field already know that this is a critical deficiency," he told Reuters Health by email. "Our group and others have shown that it does not take much time to implement either."

An overall cultural shift is also changing how surgeons make decisions about procedures near the end of life, said Dr. Pasithorn Suwanabol of the University of Michigan Medical School in Ann Arbor.

Suwanabol, who wasn't involved with this study, published a study last month which found that surgeons know about the benefits of palliative care but find it difficult to know when and how to start palliative care conversations and integrate the services. Part of this is not being able to predict what will happen next to the patient, Suwanabol said.

"We need to better predict patient trajectories and outcomes so we can better meet their palliative care needs," she told Reuters Health by email. "Studies should also measure patient needs from their perspective, not only from the perspective of the surgeons."

SOURCE: http://bit.ly/2khHlQU

Surgery 2018.