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Implications of Perioperative Morbidity for Long-Term Outcomes

The practices of anesthesiology, surgery, and critical care are continuously improving. Through advances in each field, a number of patients with increasingly severe comorbidities are undergoing riskier and more complex operations and experiencing better outcomes. In recent years, intraoperative mortality has decreased by a factor of 10. Nonetheless, perioperative morbidity and mortality remain high. If perioperative mortality were classified as a disease, it would be the…

The MD Anderson Cancer Center Moon Shots Program®: A Global Priority

Introduction The University of Texas MD Anderson Cancer Center’s Moon Shots Program® is a collaborative effort to accelerate the development of scientific discoveries into clinical advances that save patients’ lives. The program was inspired by President John F. Kennedy’s speech in Houston in 1962, where he declared our nation’s mission to go to the moon. Launched in 2012, the Moon Shots Program® began under the leadership…

Big Data, Advances in Computational Sciences, and Oncology Care

As information technology has matured, organizations and industries embracing the use of data-driven analytics to guide services has profoundly changed the human experience. Just-in-time inventory, predictive pricing models and simple applications such as web searches have generated immense gains in productivity, efficiency, and reliability. The past 40 years have also seen a revolution in the use of data in health care. Within medicine there is an…

Research in Perioperative Care of the Cancer Patient: Opportunities and Challenges

It is estimated that 30%–40% of men and women will be diagnosed with cancer in their lifetime. In those patients, cancer will be a major cause of death. Therefore, it is anticipated that millions of patients will die of cancer every year worldwide. Several advances in diagnostic technologies have allowed an early stage diagnosis of cancer, where surgery plays a major role in the cure. Furthermore,…

The Costs of Postoperative Complications After Major Abdominal Surgery: Opportunities and Challenges

Key Points Major abdominal surgery is associated with a high prevalence of complications. Postoperative complications are associated with increased hospital costs. Postoperative complications are associated with increased hospital length of stay. Minor complications (Clavien-Dindo grade I and II) are common and associated with a significant increase in costs. Preventing complications is a key target for cost containment. Introduction Cost-effective health care in the hospital setting is…

Economics of Cancer Care Delivery: Opportunities and Challenges

Introduction Cancer is an intensely emotional disease that places much of one’s life in jeopardy. The total cost of cancer care increased from $124 billion in 2010 to at least an estimated $206 billion in 2020. Some articles quote at least 42% of cancer patients deplete their life savings within 2 years of a cancer diagnosis. Cancer patients file for bankruptcy at least 2.6 times more…

Ethics in Cancer Care Delivery—Do Not Resuscitate

Introduction The National Cancer Act, also known as the “War on Cancer” Act, was signed into law in 1971. Thanks to the Act’s support for ongoing cancer-related research, the number of cancer survivors in the United States has been progressively increasing. Today, nearly 70% of those diagnosed with cancer will be alive after 5 years. It is predicted that in 2026 there will be 20.3 million…

Shared Decision-Making and Advance Care Planning in the Cancer Care Journey

Introduction Shared decision-making (SDM) in cancer care seems to state the obvious. What other kinds of decision-making are ethical for oncologic patients, or in fact, any patient? Despite this self-evident truth, the widespread corporatization of health care across many countries and cultures forces the issue of SDM into this text and into daily clinical life in both primary and specialty cancer centers. Although it is increasingly…

Symptom Assessment, Patient-Reported Outcomes, and Quality of Life Considerations in Perioperative Care for Patients With Cancer

Introduction It is imperative that patients with cancer are followed closely, so as to maximize treatment benefit while minimizing complications; thus monitoring the severity of symptoms and functional impairment is a critical component of patient care. Many stakeholder groups (e.g., clinicians, patients, patient advocates, those interested in quality assurance) have made a strong case for the inclusion of patient-reported outcomes (PROs) in routine oncology practice. ,…

Enhanced Surgical Recovery and Cancer

Introduction Globally, cancer is the second leading cause of death in the developed world. , It is estimated that up to 50% of inpatient admissions worldwide are for a diagnosis of cancer. As cancer prevalence increases over time, an even larger number of cancer patients will need anesthesia services for perioperative and periprocedural care. Despite significant immunologic advances in cancer care, surgery will continue to be…

Value Proposition in Cancer Care: Quantifying Patient-Centered Value in a Comprehensive Cancer Care Center

Radar Plots A Comprehensive Value Equation for a Comprehensive Cancer Center Over the past decade, many forms of the value equation have emerged from the original “Value = Outcomes/Cost” framework promulgated by Professors Michael Porter, Elizabeth Teisberg, and Robert Kaplan of the Harvard Business School. Health care systems, hospital alliances, government health care funders, and even individual providers and health care administrators within the same institution…

Special Considerations for Intensive Care Management of Pediatric Patients With Cancer

Pediatric patients undergoing treatment for cancer may require intensive care at any time during their diagnostic and treatment courses. Caring for pediatric cancer patients in the intensive care unit requires skilled, specially trained members of the medical team to provide around the clock care for this distinct patient population. This chapter will focus on critical care issues of pediatric cancer patients, including the need for intensive…

Chronic Pain and Palliative Care in the Pediatric Patient

Introduction Pain is a common and troubling symptom among pediatric cancer patients in both the inpatient and outpatient settings. , In this chapter we will provide a comprehensive overview of chronic pain and its management in pediatric cancer patients. We will also discuss pediatric palliative care and how it can be of great benefit to this vulnerable population. Pain Presentations Pain is a complex entity that…

Do Not Resuscitate and the Terminally Ill Child

Introduction Cancer is the leading cause of disease-related death in children in the United States. Despite the numerous advances in pediatric oncology, some children are diagnosed with terminal malignancies and many others will become terminal later in their cancer trajectory. A child may die as a result of direct cancer progression or complications of treatment. For instance, uncontrolled invasion of cancer into major organs and bone…

Anesthesia for Procedures Outside of the Operating Room

Introduction Nonoperating room anesthesia (NORA) and anesthesia in the nontheatre environment (ANTE), as the names suggest, provide anesthesia services at locations outside of the safe confines of the operating room. Anesthesia services are being requested at a multitude of locations as diagnostic modalities become more complex and as interventional and therapeutic modalities provide less invasive treatment options. These locations have their own unique challenges, and guidelines…

General Principles for Intensive Care Management of Pediatric Patients With Cancer

Introduction/Overview The most common cancers in the pediatric population are acute leukemia, central nervous system (CNS) tumors, nephroblastoma, neuroblastoma, lymphoma, and sarcoma (see Chapter 45 ). The most common surgeries performed in pediatric patients with cancer are for central access for treatment (port or central line placement) and tumor resections. Caring for these children in the postoperative period requires knowledge of their cancer and previous therapies.…

Intraoperative Management: Considerations for Specific Procedures in Children with Cancer

Anesthetic Management of the Child with an Anterior Mediastinal Mass Mediastinal masses may arise from structures normally located in the mediastinum, from those that pass through the mediastinum during development, or from metastatic disease that arises from tumors elsewhere in the body. In children, mediastinal masses tend to be more prevalent in males than in females. , The majority are caused by lymphomas, followed by bronchial…

Preoperative Assessment of the Pediatric Patient With Cancer

Introduction Childhood cancers make up less than 1% of all newly diagnosed cancers each year. However, with increasing survival rates, an increasing number of pediatric patients will present for surgery and/or procedures related to their cancer diagnosis. Many of these patients will require anesthesia, often multiple times, and thorough preoperative assessment and optimization is therefore essential to ensure successful outcomes from cancer surgery. The preoperative assessment…

Overview of Pediatric Cancers

Introduction The incidence of childhood cancer has been steadily increasing over the last few decades, from approximately 13 per 100,000 in 1975 to over 17 per 100,000 in 2005. While pediatric malignancies account for only 1% of all cancers diagnosed each year, cancer is the leading cause of death by disease in children aged 1–19 years. In the United States alone, each year an estimated 15,780…

Integrating Rehabilitative and Palliative Care Principles Within Acute Care Practice

Introduction From the time that we take our first breath, there is one thing that is inevitable and that is death. The journey from birth to death defines life, and how well it is spent defines its quality. To ensure good quality of life for our patients, we must understand palliative care and rehabilitative measures and that early integration of these measures could promote a better…