QUALITY-OF-LIFE IN PATIENTS WITH CANCER OF THE ESOPHAGUS AND GASTRIC CARDIA - A CASE FOR PALLIATIVE RESECTION

Objective: To evaluate quality-of-life (QOL) parameters in patients un dergoing esophagectomy, curative or palliative, for carcinoma. Design: Nonconsecutive case series. Patients: Eighty-eight patients who under went esophagectomy for cancer (curative, n=49 [56%]; palliative, n=39 [44%]) provided QOL assessments over an 18-month period. Setting: Proc edures for referral care were performed by a single team of clinicians in a tertiary referral center. Evaluations of QOL were made by 1 inde pendent trained investigator. Outcome Measures: Data were documented b y questionnaire at interview and parameters evaluated included an esop hageal module for the type and quantity of food intake, severity of re lated symptoms on eating, Eastern Cooperative Oncology Groups (ECOG) p erformance status, sleep, pain, leisure activity, working capacity, ou tlook on life, general wellbeing, and support from family and friends. A summation of selected parameters was used to calculate a total scor e. Results: Significant improvements were recorded in both the curativ e and palliative groups for at least 1 year following surgery in the t ype (P<.03) and quantity (P<.03) of food intake and severity of diet-r elated symptoms (P<.02), when compared with preoperative consideration s. Findings were comparable between the groups with regard to dietary intake. Pain status and total scores were worse in the palliative grou p at 9 months postoperatively but no significant differences between t he groups were evident at any time for sleep, leisure activity, and EC OG performance status. Conclusions: To our knowledge, there are no pre vious data regarding a comparison of QOL considerations in patients wh o have undergone either potentially curative or palliative esophagecto my for malignant disease. Data analysis revealed that palliative esoph agectomy provided enhanced QOL with marked symptomatic benefits and en joyment of daily living comparable to that observed following curative resection.