Patient-reported outcomes in palliative gastrointestinal stenting: a Norwegian multicenter study

Abstract

BackgroundThe clinical effect of stent treatment has been evaluated by mainly physicians; only a limited number of prospective studies have used patient-reported outcomes for this purpose. The aim of this work was to study the clinical effect of self-expanding metal stents in treatment of malignant gastrointestinal obstructions, as evaluated by patient-reported outcomes, and compare the rating of the treatment effect by patients and physicians.MethodsBetween November 2006 and April 2008, 273 patients treated with SEMS for malignant GI and biliary obstructions were recruited from nine Norwegian hospitals. Patients and physicians assessed symptoms independently at the time of treatment and after 2 weeks using the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire supplemented with specific questions related to obstruction.ResultsA total of 162 patients (99 males; median age = 72 years) completed both assessments and were included in the study. A significant improvement in the mean global health score was observed after 2 weeks (from 9 to 18 on a 0–100 scale, P < 0.03) for all stent locations. Both patients and physicians reported a significant reduction in all obstruction-related symptoms (>20 on the 0–100 scale, P < 0.006) after SEMS treatment. The physicians reported a larger mean improvement in symptoms than did the patients, mainly because they reported more severe symptoms before treatment.ConclusionSEMS treatment is effective in relieving symptoms of malignant GI and biliary obstruction, as reported by patients and physicians. The physicians, however, reported a larger reduction in obstructive symptoms than did the patients. A prospective assessment of patient-reported outcomes is important in evaluating SEMS treatment.

Prediction of survival following percutaneous biliary drainage for malignant biliary obstruction

“…Though some reports suggested that patients with advanced malignant biliary obstruction, who were beyond chemotherapy, should not be offered PTBD; [11] other studies have shown improvement in pruritus and other high-bilirubin symptoms post procedure due to drop in bilirubin levels. [14,26] In one study, the patients' quality of life was observed to improve after PTBD despite that serum bilirubin level did not drop down to normal; where mean serum bilirubin level before PTBD was 19.85 mg/dL and after the procedure at 1 month it became 6.02 mg/dL. [27] Unfortunately, due to the retrospective nature of our study, we could not evaluate for patients' quality of life, pre-and post-procedure.…”

Development and preliminary validation of the pancreatic cancer disease impact score

“…1). The reduced focus on anxiety may be related to the adaptation to the disease after proper information and that reduced reporting of itchiness may be explained by procedures like stenting [22]. However, both these dimensions remained in the PACADI score since they obviously are important in the early phases of the disease, which may be the phases of largest interest when considering current and future therapeutic options.…”

To Stent or Not to Stent: An Evidence-Based Approach to Palliative Procedures at the End of Life

“…The study found significant improvement in emotional, cognitive, and global health ( P < 0.01) in the patients who survived to follow-up, improvement in pruritus and jaundice ( P < 0.01), and improved anorexia, diarrhea, and sleep ( P < 0.01). A study of endoscopic stents in 40 patients with malignant biliary obstruction 9 found statistically significant improvements after two weeks in EORTC QLQ-C30 global health function (from 30 to 48; P = 0.003) and in symptoms, including pain and pruritus. A third study examined 109 patients (94% with advanced disease) and found a statistically significant improvement in pruritus at one month (2.26–0.75; P < 0.01), using a visual analogue scale, but a significant decrease in QOL (101.3–94.7; P < 0.01), using the Functional Assessment of Cancer Therapy-Hepatobiliary instrument.…”