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The relationship between quality of life (EORTC QLQ C-30) and survival and treatment in patients with gastro-oesophageal cancer.

McKernan, Margaret (2008) The relationship between quality of life (EORTC QLQ C-30) and survival and treatment in patients with gastro-oesophageal cancer. MSc(R) thesis, University of Glasgow.

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Abstract

Gastro-oesophageal cancer is the third commonest cause of cancer death in the UK. Each year, there are approximately 16,500 new cases diagnosed and over 13,000 deaths attributable to the disease. Overall survival is poor with the majority of patients presenting with advanced, inoperable disease and less than 15% surviving 5 years, therefore ensuring the best quality of life is paramount for these patients. The traditional end points of tumour response, toxicity and survival are limited in discerning differences between the various treatments for gastro-oesophageal cancer. Irrespective of treatment, the majority of patients with advanced disease do not achieve a response to treatment or an increased survival. Consequently, in the last decade, there has been considerable interest in including some measure of quality of life in the assessment of patients with cancer and their continuing aftercare, as it provides information on the patient’s perception of their health and the effectiveness and side effects of their treatment. Quality of life has been an implied outcome since the earlier days of health care. In 1947, the World Health Organisation defined health as “a state of complete physical, mental and social well-being and not merely the absence of disease”. The first scale to quantify patient’s activity level and capability was developed in 1948 by Karnofsky. Since that time, numerous scales have been developed to assess an individual’s physical, psychological and social response to disease and its treatment. The aim of this thesis is to examine the baseline relationship between clinico-pathological characteristics and quality of life in gastro-oesophageal cancer patients and to further assess the long-term effect of treatment (surgery, oncological treatment or supportive care). For this study we have used the EORTC QLQ-C30, the ECOG performance status scale and the dysphagia score. In Chapter 2, an assessment of quality of life, clinical and pathological variables was undertaken on 152 patients. This study demonstrated there were major differences in quality of life and symptom scores with increasing stage of disease. In particular, social functioning, fatigue, appetite loss and global quality of life were all impaired with increasing tumour stage. As might be expected in view of these associations, the majority of quality of life and symptom scores predicted survival on univariate analysis. It was of interest, however, that appetite loss remained an independently significant prognostic factor even after adjustment for TNM stage and treatment. Furthermore in the present study C-reactive protein concentrations were available in 94 (62%) patients, at the time of quality of life assessment. An elevated C-reactive protein concentration was associated with increased appetite loss and when included in the multivariate analysis, an elevated C-reactive protein concentration was independently associated with poorer cancer specific survival. However, even those patients without an elevated C-reactive protein concentration, reported some appetite loss and the independent prognostic value of appetite loss remained, thus confirming the importance of appetite loss in the multifactorial nature of weight loss and poor outcome in these patients. The effect of treatment on aspects of quality of life including appetite loss has rarely been examined. Furthermore, there are, to our knowledge, no studies which have examined the effect of surgery on quality of life beyond 3 years. Therefore in Chapter 3 we examined the effect of treatment (surgery, oncological treatment or supportive care) on quality of life (EORTC QLQ-C30) for up to fours years post treatment in 160 patients. Patients who underwent surgery had, at study entry, better global quality life including better physical and role functioning and less fatigue and appetite loss compared with those patients who did not receive surgery. Furthermore, the effect of oesophageal surgery on global quality of life appeared to be more profound and persistent. In contrast, in patients with inoperable disease, the poor quality of life measures at study entry remained poor on follow-up whether patients received oncological input or supportive care. In conclusion, the results of the present studies have indicated that appetite loss is important in determining quality of life in gastro-oesophageal cancer patients and is independently associated with poor survival. Furthermore, the effect of surgery has a long lasting and profound effect on quality of life in this cohort of patients.

Item Type: Thesis (MSc(R))
Qualification Level: Masters
Keywords: Gastro-oesophageal cancer, quality of life, survival and treatment
Subjects: R Medicine > RA Public aspects of medicine
R Medicine > R Medicine (General)
Colleges/Schools: College of Medical Veterinary and Life Sciences > Institute of Cancer Sciences
Supervisor's Name: McMillan, Dr Donald. C
Date of Award: 2008
Depositing User: Ms Margaret McKernan
Unique ID: glathesis:2008-312
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 19 Aug 2008
Last Modified: 10 Dec 2012 13:17
URI: http://theses.gla.ac.uk/id/eprint/312

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