Quality and Outcome Metrics for Palliative Interventions in Cancer Patients

Purpose: Quality and outcome metrics for palliative IR interventions in oncology patients do not exist.  By examining metrics such as 30-day mortality and 30-day readmission rates after surgery,  the National Surgical Quality Improvement Program (NSQIP) established pivotal surgical quality thresholds.  The purpose of this study was to establish baseline outcome measures for palliative IR interventions in cancer patients and to evaluate the predictive value of risk factors associated with poor surgical outcomes to IR interventions.

Materials and Methods: A single institution retrospective review of two palliative interventions, venting gastrostomy tube placement and intraperitoneal drainage catheter placement, performed between 4/1/2020 – 10/1/2022 was conducted at a cancer center. In addition to demographic characteristics, the presence of five comorbidities (performance status, diabetes, COPD, hypertension requiring medication, and myocardial infarction) found to recapitulate patient frailty for patients undergoing surgery (Subramaniam et al.) was evaluated for each patient. Cumulative incidence functions were calculated for 30-day readmission rates following the intervention, with mortality considered a competing risk. Univariable and multivariable analysis for the significance of the 5 frailty indices on 30-day readmission rates was performed. All statistical analysis was conducted using R (R Foundation).

Results: A total of 973 patients were identified during the study period, with a median age of 61 (52 – 69). Intraperitoneal catheters were placed in 79% of patients, and venting gastrostomy tubes in 21%. The most common ECOG status was 2 (48%), followed by 3 (15%), and 4 (2.8%). The most common histology was adenocarcinoma (21%). Diabetes, COPD, MI, and hypertension requiring medications were present in 32%, 1.8%, 3.4%, and 22% of the study cohort, respectively. The overall survival rate at 30 days was 38%, and of those patients alive at 30 days, the hospital readmission rate was 13%. On both univariable and multivariable analysis, the only covariate associated with 30-day readmission was age; none of the 5 surgical frailty variables correlated with this outcome.

Conclusion: Mortality following palliative IR interventions are expected and 30-day readmission rates are low. Frailty, which has been associated with poor surgical outcomes, may not be relevant to oncology patients undergoing palliative IR interventions.