Was It Worth It? Critical Evaluation of a Novel Outcomes Measure in Oncologic Palliative Surgery

• Published in: Journal of the American College of Surgeons Vol. 236; no. 6; pp. 1156 - 1162
• Main Authors: Cohen, Joshua T, Beard, Rachel E, Cioffi, William G, Miner, Thomas J
• Format: Journal Article
• Language: English
• Published: United States 01-06-2023
• Subjects: Aged; Humans; Medical Oncology; Neoplasms - surgery; Palliative Care; Patient Satisfaction; Reoperation
• ISSN: 1072-7515; 1879-1190
• DOI: 10.1097/XCS.0000000000000649

Patient selection for palliative surgery is complex, and appropriate outcomes measures are incompletely defined. We explored the usefulness of a specific outcomes measure "was it worth it" in patients after palliative-intent operations for advanced malignancy.
A retrospective review of a comprehensive longitudinal palliative surgery database was performed at an academic tertiary care center. All patients who underwent palliative-intent operation for advanced cancer from 2003 to 2022 were included. Patient satisfaction ("was it worth it") was reported within 30 days of operation after palliative-intent surgery.
A total of 180 patients were identified, and 81.7% self-reported that their palliative surgery was "worth it." Patients who reported that their surgery was "not worth it" were significantly older and were more likely to have recurrent symptoms and to need reoperation. There was no significant difference in overall, recurrence-free, and reoperation-free survival for patients when comparing "worth it" with "not worth it." Initial symptom improvement was not significantly different between groups. Age older than 65 years (hazard ratio 0.25, 95% CI 0.07 to 0.80, p = 0.03), family engagement (hazard ratio 6.71, 95% CI 1.49 to 31.8, p = 0.01), and need for reoperation (hazard ratio 0.042, 95% CI 0.01 to 0.16, p < 0.0001) were all independently associated with patients reporting that their operation was "worth it."
Here we demonstrate that simply asking a patient "was it worth it" after a palliative-intent operation identifies a distinct cohort of patients that traditional outcomes measures fail to distinguish. Family engagement and durability of an intervention are critical factors in determining patient satisfaction after palliative intervention. These data highlight the need for highly individualized care with special attention paid to patients self-reporting that their operation was "not worth it."