The Surgical Treatment of Cancer
Carey A. Cullinane, M.D., M.P.H., Tami Borneman, M.S.N., David D. Smith, Ph.D., David Z. J. Chu, M.D., Betty R. Ferrell, Ph.D., Lawrence D. Wagman, M.D.
Background
Costs associated with the provision of medical care continue to
escalate. Therefore, providers must evaluate the cost-effectiveness and benefit to
individual healthcare practices. The authors evaluated the immediate and shortterm
resource utilization needs of patients undergoing surgical intervention with
curative or palliative intent.
Methods
Three hundred two patients undergoing surgery with therapeutic intent
were observed from the time of admission for intervention until the time of death
or until 6 months from the time of the surgical procedure. Surgeons preoperatively
identified each case as either curative or palliative in intent. Demographic information,
as well as the nature of all interactions with the cancer center, was
recorded.
Results
Surgeons identified 58 (19%) procedures as palliative and 244 (81%) as
curative in intent. Demographic characteristics between the two groups were
similar, although recurrent or metastatic disease was more often present in palliative
rather than curative patients and palliative intent patients were
more likely to have received previous therapy. During the 6-month period, 4690
encounters occurred with the cancer center. The mean number of encounters per
patient in each group was similar, although curative intent patients were more
likely to have visits with therapeutic intent including chemotherapy administration
, radiation , or repeat surgical procedures . In
contrast, palliative patients were more likely to be admitted for management of
symptoms and had fewer hospital-free days than did curative patients
.
Conclusions
The average number of encounters for patients undergoing treatment
of disease was not signi.cantly different, suggesting that patients undergoing
surgery with palliative intent do not require a greater amount of resources than
curative intent patients. The nature of the interactions, however, was different,
suggesting that resource needs are different and may need to be anticipated in the
assessment of how better quality outcomes can be achieved in the palliative
surgery setting.
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