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Quality-of-life deficits before cancer surgery linked to higher risk of complications

REUTERS/Jonathan Bachman
The patients with complications had spent an average of 3.5 days longer in the hospital than those without complications.

A person’s quality of life before cancer surgery can help predict whether he or she will develop a serious medical complication immediately after the operation, according to a study published this week by researchers at the Mayo Clinic in Rochester.

People with a poor quality of life were found to be almost three times more likely to develop a post-surgical complication, such as excessive bleeding, infection, pneumonia or a sudden heart problem, before they left the hospital than those with an average or good quality of life.

“Quality of life matters,” said lead author Dr. Juliane Bingener, a gastroenterologic surgeon at the Mayo Clinic, in a phone interview Wednesday with MinnPost. “It’s not the only thing, and it’s probably not the most important thing in predicting post-operative complications. But it does matter.”

Quality of life, which is measured through carefully designed questionnaires, does not just include physical well-being, such as how much pain, fatigue or nausea the patient is experiencing. It also includes aspects of the patient’s financial, spiritual, emotional, mental and social well-being — how much emotional support they are getting from their family, for example, and how stressed they feel about their finances.

Study details

For the study, Bingener and her colleagues analyzed quality-of-life data collected two decades ago from patients participating in a large national clinical trial that had compared laparoscopic and open surgery in patients with colon cancer. (Both types of surgery were found to have similar outcomes.)

“At that time, the data was not intended to be used as a predictor of something, but just to compare the two procedures,” said Bingener.

The analysis found that of the 431 patients enrolled in the qualify-of-life portion of the earlier study, 81 (19 percent) had experienced post-surgical complications while still in the hospital, including two deaths (0.5 percent).

Juliane Bingener-Casey, M.D.
Dr. Juliane Bingener

The patients with complications had spent an average of 3.5 days longer in the hospital than those without complications.

The analysis also revealed that 55 (13 percent) of the 431 patients had a quality-of-life “deficit” — defined as an overall quality-of-life score of less than 50 on a 100-point scale.

The researchers then compared the quality-of-life scores with the incidents of post-surgical complications.

“We found that if you had a deficit of quality of life before surgery, you were much more likely to have a serious complication before you left the hospital — 16 percent if you had the deficit versus 6 percent if you didn’t,” said Bingener. “That’s significant.”

“We’re talking about complications that were serious enough to have another intervention,” she added.

Needs to be a team effort

These findings suggest that screening cancer patients for quality-of-life issues before surgery and then intervening, when necessary, with behavioral therapy or other types of assistance might help prevent post-surgical complications, said Bingener.

In fact, she and her Mayo colleagues are about to undertake another study designed to determine if such a process would be both feasible and effective.

Helping patients raise their quality-of-life scores will not be easy, however, and requires a team effort that includes the patient’s physicians as well as his or her caregivers, whether family or friends, said Bingener.

“The approach has to be very individual,” she stressed. “Some people may have financial issues that weigh very heavily on them. Others may have very little family support. Others may have mental health issues.”

In the past, the focus of cancer treatment was almost exclusively on survival because it was so difficult to achieve. Today, however, the struggle is not just for survival, said Bingener, but also for preserving as much of the patient’s normal life as possible.

The study was published online Tuesday in the Journal of Gastrointestinal Surgery.

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