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Factors Influencing End-of-Life Decisions in Cancer Patients After Traumatic Injuries.
Priya Pathak1, Jonathan Laredo2, Sonal Swain3
1The Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Surgery, Duke University School of Medicine, Durham, North Carolina.
The Journal of Surgical Research
|July 2, 2025
Summary
Cancer patients with metastatic disease had significantly higher odds of withdrawal of life-sustaining treatment (WLST) after traumatic injury. Advance directives strongly influenced these end-of-life decisions in trauma care.
Area of Science:
- Trauma Surgery
- Oncology
- Critical Care Medicine
Background:
- Severe traumatic injuries often lead to poor outcomes.
- Withdrawal of life-sustaining treatment (WLST) is common after traumatic brain injury.
- The impact of pre-existing cancer on WLST in trauma patients is not well understood.
Purpose of the Study:
- To investigate the association between pre-existing metastatic cancer and WLST in trauma patients.
- To compare WLST rates among trauma patients with and without cancer, considering chemotherapy status.
- To identify factors influencing end-of-life decisions in trauma patients with cancer.
Main Methods:
- Retrospective cohort study using the American College of Surgery Trauma Quality Programs (2022).
- Included patients aged 18+ with data on disseminated cancer and chemotherapy.
- Used propensity score matching and logistic regression to analyze WLST association.
Main Results:
- Patients with metastatic cancer (with or without chemotherapy) had 2-3 times higher odds of WLST compared to those without cancer.
- Severe injuries increased WLST odds by 2.83 times.
- Advance directives were strongly associated with increased WLST (OR 3.62).
Conclusions:
- Metastatic cancer significantly increases WLST odds in trauma patients, irrespective of chemotherapy.
- Advance directives play a crucial role in end-of-life decisions for trauma patients with cancer.
- Emphasizes the need for personalized care and patient preferences in trauma settings.
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