Control group (usual care)

After consultation with their surgeon with a decision to operate, patients have a preoperative evaluation by an anesthesia provider and any other consultations deemed necessary. The surgical team provides postoperative follow-up in the hospital, in some cases with assistance from an anesthesia pain team. After hospital discharge, patients generally have one follow-up visit with their surgeon 3–6 weeks postoperatively, with more visits if patients have persistent problems related to their surgery (e.g., wound problems). If the patient needs further chemotherapy or radiotherapy, they generally see those providers (who may or may not be at VUMC) in the ensuing months. If no further cancer-directed therapy is needed, surveillance (either by the surgeon or oncologist) continues, usually at annual or semi-annual intervals. At our institution, routine practice does not include referral to a palliative care provider unless the patient has very difficult-to-manage symptoms or is near the end of life. Retrospective review of patients undergoing surgery for the malignancies in the SCOPE Trial at VUMC revealed that fewer than 10% received a palliative care consultation at any point in their care. In almost all cases, palliative care consultation occurred after surgery. Nevertheless, control group patients can receive palliative care consultations if their clinical providers desire. Palliative care consultations for control patients will be monitored by electronic medical record review, and number and timing of palliative care consultations will be recorded.