Quality of life after palliative treatment for oesophageal carcinoma -- a prospective comparison between stent placement and single dose brachytherapy

Abstract

Metal stent placement and single dose brachytherapy are commonly used treatment modalities for the palliation of inoperable oesophageal carcinoma. We investigated generic and disease-specific health-related quality of life (HRQoL) after these palliative treatments. Patients with dysphagia from inoperable oesophageal carcinoma were randomised to placement of a covered Ultraflex stent (n = 108) or single dose (12 Gy) brachytherapy (n = 101). We obtained longitudinal data on disease-specific (dysphagia score, European Organisation for Research and Treatment of Cancer (EORTC) OES-23, visual analogue pain scale) and generic (EORTC Quality of Life-Core 30 Questionnaire (QLQ-C30), Euroqol (EQ)-5D) HRQoL at monthly home visits by a specially-trained research nurse. We compared HRQoL between the two treatments and analysed changes in HRQoL during follow-up. Dysphagia improved more rapidly after stent placement than after brachytherapy, but long-term relief of dysphagia was better after brachytherapy. For generic HRQoL, there was an overall significant difference in favour of brachytherapy on four out of five functional scales of the EORTC QLQ-C30 (role, emotional, cognitive and social) (P < 0.05). Generic HRQoL deteriorated over time on all functional scales of the EORTC QLQ C-30 and EQ-5D, in particular physical and role functioning (on average -23 and -24 on a 100 points scale during 0.5 years of follow-up). This decline was more pronounced in the stent group. Major improvements were seen on the dysphagia and eating scales of the EORTC OES-23, in contrast to other scales of this disease-specific measure, which remained almost stable during follow-up. Reported levels of chest or abdominal pain remained stable during follow-up in both treatment groups, general pain levels increased to a minor extent. The effects of single dose brachytherapy on HRQoL compared favourably to those of stent placement for the palliation of oesophageal cancer. Future studies on palliative care for oesophageal cancer should at least include generic HRQoL scales, since these were more responsive in measuring patients' functioning and well-being during follow-up than disease-specific HRQoL scales.