A lack of consistent definitions for palliative surgical procedures may impact patient outcomes and symptoms, a recent clinical study has found.
Physicians from Brigham and Women’s Hospital recently examined trends in palliative surgical procedures aimed at alleviating symptoms in patients with serious and life-limiting illnesses. Their clinical research was recently published in Oxford University Press’ British Journal of Surgery (BJS).
Palliative surgeries can provide symptomatic relief and reduce health care burdens for certain seriously ill patients alongside goals-of-care conversations and careful consideration, the research found.
But not all palliative surgeries result in beneficial outcomes for patients, according to researcher Dr. Elizabeth Lilley. Lilley is a surgical oncologist and palliative care physician at Boston-based Brigham and Women’s Hospital and Dana-Farber Cancer Institute.
More research is needed to provide clearer definitions around what constitutes as a palliative surgery versus a life-sustaining procedure that helps patients control a disease or condition, Lilley said.
“Unfortunately there isn’t an accepted or standardized way that we think about palliative surgery,” Lilley told Palliative Care News. “The procedures we looked at were a mixed bag of those intended to alleviate symptoms or to help patients with a purpose of understanding how we as researchers and surgeons really define what palliative care surgery is, because there is not one accepted definition.”
An increasingly diverse range of surgical procedures can fall into the palliative category, reflective of the swath of serious, chronic and terminal conditions among patients, Lilley said.
Patients may consider palliative surgery for relief from nausea, vomiting or constipation through the removal of a bowel obstruction. These surgeries can reduce these symptoms in patients with various serious illnesses and allow them to return home versus receiving care in a higher-cost setting, Lilley stated.
Other types of palliative surgeries may be more difficult to decide upon. They also carry risks to physical and emotional health, she added.
The research found that patients often struggle with decisions related to palliative surgeries, with many indicating a lack of information on the potential outcomes as the leading factor.
“Patients can get symptom relief from palliative surgery,” Lilley said. “There are also patients who have really widespread disease where there is no benefit or their symptoms worsen over time. What we found is that being able to share more information would help so many clinicians and patients who are struggling with these decisions. I don’t think we have the right language yet to help patients weigh those decisions.”
Cancer patients are among those who must weigh the potential benefits and risks of palliative surgeries, Lilley said. They may have the option to undergo an operation for a health issue that is not yet causing symptoms but will in the future, such as melanoma cancer patients who are asymptomatic, she explained.
Palliative surgery decisions related to addressing patients’ pain can be among the toughest to consider. A patient may be experiencing high, consistent levels of pain that a surgery could help alleviate, but a procedure may not be in line with goal-concordant care, Lilley said.
Having conversations with these patients about their goals of care and what quality of life looks like for them can help them make informed decisions about these procedures, she stated.
“Now more and more, we’re doing surgeries for so many different reasons,” Lilley said. “Current research measures all sorts of things and never quite gets to the root of deciding whether or not a surgery will help a patient. More research can give us answers that would really help guide important decisions for patients who are sick and having to make a choice about an invasive operation.”
