The study was presented by Betty R. Ferrell, PhD, RN, a research scientist with City of Hope Cancer Center in Los Angeles, who has led the effort to bring palliative oncology surgery to the forefront.

"One of our first messages is that people should consider surgery. We?re finding that there are very good surgical techniques now that are less invasive and can be done on an outpatient basis," says Ferrell. "So, even someone who may only live for four or six months might be able to have a short stay in the hospital and benefit from a better quality of life during their months," she says.

While many studies have focused on the benefits and drawbacks of palliative cancer care involving chemotherapy and radiation, few have focused on the benefits of palliative surgery. This type of treatment could could shrink a tumor or eliminate an area where the cancer has spread so that it doesn?t take away a person?s ability to breathe, eat, remain functional, and be free of pain.

Ferrell and her associates surveyed cancer surgeons who are members of the national Society of Surgical Oncologists and found little focus on palliative care during the physicians? education and training. Ninety percent of the doctors surveyed said they received 10 hours or less of palliative care education during medical school and 79% said they had 10 hours or less of palliative care training during their surgical residencies, according to Ferrell.

The surgeons said their greatest ethical dilemma regarding palliative care was their ability to provide honest information without destroying hope, she says. A key finding of the survey was the surgeons? desire for increased education in palliative care, says Ferrell.

"It?s important to understand that the same treatments that are given when cure was the goal for cancer ? that is surgery, chemotherapy, radiation therapy ? can be used in advanced cancer to relieve symptoms or prevent complications. Palliation itself is a worthwhile goal, particularly as it improves quality of life," says Frank Baker, PhD, vice president for behavioral research and director of the Behavioral Research Center at the ACS.

Earlier this month, Ferrell received notice from the ACS that it will fund a large-scale, four-year research project on the decisions and outcomes of palliative surgery beginning in July 2001.

"The results of the pilot experience over the past year have been so impressive and we really feel that this is a very critical area that hasn?t been explored. We are very excited that we?ll be able to launch this in a big way," Ferrell says.

The research doesn?t indicate that everyone would benefit from surgery. Researchers need stronger data that illustrate outcomes of palliative surgery, including which surgeries are successful, which are not, and when they should be performed, she says. "It?s true that as with any other treatment, there is the ability to do harm?not just good," Ferrell says. "That?s what we?ll be looking at in the four-year project."

"Quality of life issues for cancer patients deserve our attention. More than 550,000 people will die of cancer in the United States in 2001. We need to be concerned about offering them the best care possible," she says.