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

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Abstract
Background. 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. Methods. 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. Results. Dysphagia grade (DG) as measured on a 5-point scale, correlated significantly with LASA (n = 92; r = −0.51; P < 0.0001) and QLI (n = 92; r = −0.43; P 0.0001) scores. In addition, there was a strong correlation between LASA and QLI scores (r = 0.678; P < 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 < 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 < 0.004). Conclusions. 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. Cancer 1992; 70:386–391.