Characteristics and Correlates of Increasing Use of Surgery in Taiwanese Cancer Patients’ Last Month of Life, 2001–2010

Tsang Wu Liu, Yen-Ni Hung, Craig C. Earle, Tsang Pai Liu, Lini Liu, Siew Tzuh Tang

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

BACKGROUND/OBJECTIVES:: Surgery offers the potential to relieve symptoms for patients with cancer at the end of life (EOL) but at significant physiological and economic costs. However, the characteristics and correlates of surgery in last month of life (EOL surgery) of patients with cancer have not been comprehensively explored. This population-based study characterized EOL surgery use and identified its correlates. METHODS:: This retrospective cohort study examined administrative data among 339,546 Taiwanese cancer decedents, 2001 to 2010. We classified procedures according to their likely intent. RESULTS:: Approximately 1 in 10 (11.44%, range: 11.08%–11.86%) patients underwent EOL surgery with an increasing utilization over time. The intention for EOL surgery was primarily palliative, followed by cancer-directed, nonmalignancy-directed, and diagnostic. EOL surgery for palliative intent increased whereas other intents decreased significantly over time. EOL surgery was more likely among those who were male, younger, and married; not diagnosed with hepatic-pancreatic or lung cancers; had no comorbidity or documented metastatic codes; and survived less than 1 year from diagnosis. The likelihood of EOL surgery use was higher for patients who received care in a teaching hospital with more acute care hospital beds and higher EOL care intensity. CONCLUSIONS:: Rates of EOL surgery are lower in Taiwan than those reported in the United States. The increasing use of EOL surgery in Taiwan is primarily for palliative intent. Appropriateness of EOL surgery should be carefully evaluated to avoid underutilizing potentially beneficial, palliative-intent surgery and overutilizing cancer-directed and other surgical procedures, especially for physicians working in hospitals with abundant health care resources and a tendency to treat at-risk patients with cancer aggressively.

Original languageEnglish
JournalAnnals of Surgery
DOIs
Publication statusAccepted/In press - Dec 10 2015

Fingerprint

Neoplasms
Taiwan
Palliative Care
Terminal Care
Health Resources
Liver Neoplasms
Pancreatic Neoplasms
Teaching Hospitals
Comorbidity
Lung Neoplasms
Cohort Studies
Retrospective Studies
Economics
Delivery of Health Care
Physicians
Costs and Cost Analysis
Population

ASJC Scopus subject areas

  • Surgery

Cite this

Characteristics and Correlates of Increasing Use of Surgery in Taiwanese Cancer Patients’ Last Month of Life, 2001–2010. / Liu, Tsang Wu; Hung, Yen-Ni; Earle, Craig C.; Liu, Tsang Pai; Liu, Lini; Tang, Siew Tzuh.

In: Annals of Surgery, 10.12.2015.

Research output: Contribution to journalArticle

Liu, Tsang Wu ; Hung, Yen-Ni ; Earle, Craig C. ; Liu, Tsang Pai ; Liu, Lini ; Tang, Siew Tzuh. / Characteristics and Correlates of Increasing Use of Surgery in Taiwanese Cancer Patients’ Last Month of Life, 2001–2010. In: Annals of Surgery. 2015.
@article{100284c5fada4b06ae4a3b00816b983c,
title = "Characteristics and Correlates of Increasing Use of Surgery in Taiwanese Cancer Patients’ Last Month of Life, 2001–2010",
abstract = "BACKGROUND/OBJECTIVES:: Surgery offers the potential to relieve symptoms for patients with cancer at the end of life (EOL) but at significant physiological and economic costs. However, the characteristics and correlates of surgery in last month of life (EOL surgery) of patients with cancer have not been comprehensively explored. This population-based study characterized EOL surgery use and identified its correlates. METHODS:: This retrospective cohort study examined administrative data among 339,546 Taiwanese cancer decedents, 2001 to 2010. We classified procedures according to their likely intent. RESULTS:: Approximately 1 in 10 (11.44{\%}, range: 11.08{\%}–11.86{\%}) patients underwent EOL surgery with an increasing utilization over time. The intention for EOL surgery was primarily palliative, followed by cancer-directed, nonmalignancy-directed, and diagnostic. EOL surgery for palliative intent increased whereas other intents decreased significantly over time. EOL surgery was more likely among those who were male, younger, and married; not diagnosed with hepatic-pancreatic or lung cancers; had no comorbidity or documented metastatic codes; and survived less than 1 year from diagnosis. The likelihood of EOL surgery use was higher for patients who received care in a teaching hospital with more acute care hospital beds and higher EOL care intensity. CONCLUSIONS:: Rates of EOL surgery are lower in Taiwan than those reported in the United States. The increasing use of EOL surgery in Taiwan is primarily for palliative intent. Appropriateness of EOL surgery should be carefully evaluated to avoid underutilizing potentially beneficial, palliative-intent surgery and overutilizing cancer-directed and other surgical procedures, especially for physicians working in hospitals with abundant health care resources and a tendency to treat at-risk patients with cancer aggressively.",
author = "Liu, {Tsang Wu} and Yen-Ni Hung and Earle, {Craig C.} and Liu, {Tsang Pai} and Lini Liu and Tang, {Siew Tzuh}",
year = "2015",
month = "12",
day = "10",
doi = "10.1097/SLA.0000000000001373",
language = "English",
journal = "Annals of Surgery",
issn = "0003-4932",
publisher = "Lippincott Williams and Wilkins",

}

TY - JOUR

T1 - Characteristics and Correlates of Increasing Use of Surgery in Taiwanese Cancer Patients’ Last Month of Life, 2001–2010

AU - Liu, Tsang Wu

AU - Hung, Yen-Ni

AU - Earle, Craig C.

AU - Liu, Tsang Pai

AU - Liu, Lini

AU - Tang, Siew Tzuh

PY - 2015/12/10

Y1 - 2015/12/10

N2 - BACKGROUND/OBJECTIVES:: Surgery offers the potential to relieve symptoms for patients with cancer at the end of life (EOL) but at significant physiological and economic costs. However, the characteristics and correlates of surgery in last month of life (EOL surgery) of patients with cancer have not been comprehensively explored. This population-based study characterized EOL surgery use and identified its correlates. METHODS:: This retrospective cohort study examined administrative data among 339,546 Taiwanese cancer decedents, 2001 to 2010. We classified procedures according to their likely intent. RESULTS:: Approximately 1 in 10 (11.44%, range: 11.08%–11.86%) patients underwent EOL surgery with an increasing utilization over time. The intention for EOL surgery was primarily palliative, followed by cancer-directed, nonmalignancy-directed, and diagnostic. EOL surgery for palliative intent increased whereas other intents decreased significantly over time. EOL surgery was more likely among those who were male, younger, and married; not diagnosed with hepatic-pancreatic or lung cancers; had no comorbidity or documented metastatic codes; and survived less than 1 year from diagnosis. The likelihood of EOL surgery use was higher for patients who received care in a teaching hospital with more acute care hospital beds and higher EOL care intensity. CONCLUSIONS:: Rates of EOL surgery are lower in Taiwan than those reported in the United States. The increasing use of EOL surgery in Taiwan is primarily for palliative intent. Appropriateness of EOL surgery should be carefully evaluated to avoid underutilizing potentially beneficial, palliative-intent surgery and overutilizing cancer-directed and other surgical procedures, especially for physicians working in hospitals with abundant health care resources and a tendency to treat at-risk patients with cancer aggressively.

AB - BACKGROUND/OBJECTIVES:: Surgery offers the potential to relieve symptoms for patients with cancer at the end of life (EOL) but at significant physiological and economic costs. However, the characteristics and correlates of surgery in last month of life (EOL surgery) of patients with cancer have not been comprehensively explored. This population-based study characterized EOL surgery use and identified its correlates. METHODS:: This retrospective cohort study examined administrative data among 339,546 Taiwanese cancer decedents, 2001 to 2010. We classified procedures according to their likely intent. RESULTS:: Approximately 1 in 10 (11.44%, range: 11.08%–11.86%) patients underwent EOL surgery with an increasing utilization over time. The intention for EOL surgery was primarily palliative, followed by cancer-directed, nonmalignancy-directed, and diagnostic. EOL surgery for palliative intent increased whereas other intents decreased significantly over time. EOL surgery was more likely among those who were male, younger, and married; not diagnosed with hepatic-pancreatic or lung cancers; had no comorbidity or documented metastatic codes; and survived less than 1 year from diagnosis. The likelihood of EOL surgery use was higher for patients who received care in a teaching hospital with more acute care hospital beds and higher EOL care intensity. CONCLUSIONS:: Rates of EOL surgery are lower in Taiwan than those reported in the United States. The increasing use of EOL surgery in Taiwan is primarily for palliative intent. Appropriateness of EOL surgery should be carefully evaluated to avoid underutilizing potentially beneficial, palliative-intent surgery and overutilizing cancer-directed and other surgical procedures, especially for physicians working in hospitals with abundant health care resources and a tendency to treat at-risk patients with cancer aggressively.

UR - http://www.scopus.com/inward/record.url?scp=84949895345&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84949895345&partnerID=8YFLogxK

U2 - 10.1097/SLA.0000000000001373

DO - 10.1097/SLA.0000000000001373

M3 - Article

C2 - 26655921

AN - SCOPUS:84949895345

JO - Annals of Surgery

JF - Annals of Surgery

SN - 0003-4932

ER -