• Tsang-Wu Liu, Yen-Ni Hung, Craig C Earle, Tsang-Pai Liu, Li Ni Liu, and Siew Tzuh Tang.
• *National Institute of Cancer Research, National Health Research Institutes, Miaoli County, Taiwan†School of Gerontology Health Management and Master Program in Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan‡Cancer Care Ontario and Ontario Institute for Cancer Research, Toronto, Ontario, Canada§Department of General Surgery, Mackay Memorial Hospital, Taipei, Taiwan, and Mackay Junior College of Medicine, Nursing and Management, New Taipei City, Taiwan¶Department of Nursing, Fu Jen Catholic University, Taipei, Taiwan||Chang Gung University, Graduate School of Nursing, Tao-Yuan, Taiwan.
• Ann. Surg. 2016 Aug 1; 264 (2): 283-90.

Background/ObjectivesSurgery 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.MethodsThis retrospective cohort study examined administrative data among 339,546 Taiwanese cancer decedents, 2001 to 2010. We classified procedures according to their likely intent.ResultsApproximately 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.ConclusionsRates 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.

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