A prospective assessment of quality of life after endoscopic intubation and laser therapy for malignant dysphagia.

Abstract

This study evaluated the effect of endoscopic treatment for malignant dysphagia on quality of life (QL) as part of a prospective comparison of Nd:YAG laser therapy and intubation. Two QL instruments were used: the Quality of Life Index (QLI) and a Linear Analogue Self-Assessment (LASA). Only 23 of 43 patients receiving laser therapy and 15 of 30 having endoscopic intubation agreed to partake in QL assessment; serial measurements until death were obtained in 13 and 9 patients, respectively. Dysphagia grade (DG) as measured on a 5-point scale, correlated significantly with LASA (n = 92; r = -0.51; P less than 0.0001) and QLI (n = 92; r = -0.43; P less than 0.0001) scores. In addition, there was a strong correlation between LASA and QLI scores (r = 0.678; P less than 0.0001). All patients followed up serially until death derived significant palliation of their dysphagia with laser treatment and intubation. Such therapy resulted in a significant initial improvement in QL, with the mean best LASA and QLI scores after treatment being higher than the corresponding mean pretreatment scores (P less than 0.004). However, this improvement proved transient; QL worsened significantly as a patient's general condition deteriorated during the final stages of the illness. The mean last post-treatment LASA and QLI scores in both groups (recorded within 5 weeks of death) were less than the corresponding mean pretreatment scores (P less than 0.004). Endoscopic palliation of malignant dysphagia results in a significant initial improvement in QL. Subsequently, QL worsens appreciably as a patient's general condition deteriorates during the terminal phase of disease.