Surgical perspectives in gastrointestinal disease: a study of quality of life outcomes in esophageal, pancreatic, colon, and rectal cancers

Abstract

Outcomes assessment in surgery traditionally has included data regarding peri-operative mortality and morbidity, as well as long-term survival and recurrence in surgical oncology. However, quality of life (QOL) is another important patient-related outcome measure. QOL data can be used to tailor treatment and improve clinical outcomes by detecting physical or psychological problems in patients that otherwise might be overlooked, but which have profound implications for the effective delivery of care. We review several well-validated QOL instruments developed specifically for use in patients with gastrointestinal malignancies, including esophageal, pancreatic and colorectal cancers, and conclude that QOL assessment routinely should be included in clinical trials of novel treatments.

Figure 1

To measure QOL, social, psychological and physical domains of illness are assessed using measurement scales (z). QOL (Q) is dependent on both subjective and objective items. For a questionnaire to be validated, Z must equal Q. (Reprinted with permission from Testa et al N Engl J Med 334: 835-840, 1996).

Figure 2

The EORTC QLQ-18 is a specific module for esophageal cancer. Patients complete the questionnaire based on QOL symptoms experienced within the last week. (Reprinted with permission from the EORTC.)

Figure 3

A: QOL after THE in patients with esophageal cancer ≥ 70 years of age. QOL declines sharply for six months and then improves, but the recovery is not durable; B: QOL after THE in patients with esophageal cancer ≤ 55 years of age. QOL declines for six months, but then improves in a more sustained fashion.