Quality of Life in Patients With Cancer of the Esophagus and Gastric Cardia

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Abstract
ALTHOUGH SURGERY offers the best prospect for potential cure of esophageal and cardia cancer,1 radical therapy may result in increased treatment-related mortality, high treatment-induced morbidity, and reduced quality of life (QOL).2 Such considerations are important as it is regarded as unethical to subject patients to treatment merely to offer them a few extra months of life, if this is at the expense of quality of survival.3 Areas of life or domains that are important to an individual have the most influence on QOL.4 The ability to enjoy food and social interaction at meal times is greatly appreciated and valued by the Chinese. Difficulty in swallowing may have disastrous consequences, with loss of one of the main pleasures of life, a meal in the company of family and friends. Surgery probably provides the most effective palliation of dysphagia,5 which is considered to be the most important indicator of QOL in patients with esophageal cancer.6 Whereas the tendency is to focus on technical aspects of therapy and relief of dysphagia, broader aspects of a patient's QOL cannot be ignored.7,8 The majority of questionnaires available to measure QOL are designed to be completed by the patient to avoid bias and interobserver variation9,10 and because it is believed that patients alone can sensibly comment on their physical and psychological status.11,12