Integration of measures of quality of life (QOL) with economic considerations is critical to define the optimal therapy for patients with malignant bile duct obstruction (MBDO). While endoscopic stealing is clearly indicated for relief of cholangitis or refractory pruritus, its role in patients with jaundice alone, abdominal pain, failure to thrive, etc., is less clear. Endoscopic stenting for these relative indications might be justified if the QOL is significantly improved. The aim of this study was to determine whether endoscopic stenting for MBDO results in an improved QOL. METHODS: A modified Functional Assessment of Cancer Therapy (FACT) is the instrument used to assess QOL. This validated, self-administered questionnaire contains 43 items which are divided into the following 5 subscales: physical well-being, social/family well-being, relationship with doctor, emotional well-being, and functional well-being. An additional concerns category was added, addressing symptoms associated with MBDO. Eighty-seven patients with MBDO filled out the questionnaire prior to biliary stenting and 30 days following stent placement. The results at 30 days were compared to pre-stenting using paired T-tests. RESULTS: Endoscopic biliary stenting resulted in a statistically significant improvement in energy levels (p < .001); nausea (p < .001); meeting family needs (p=.04); pain (p=.003); feeling of well-being (p<.001); time spent in bed (p < .001); nervousness (p < .001); sadness (p=.002); coping with illness (p=.002); fear of dying (p=.004); enjoy life (p=.017); acceptance of illness (p < .001); sleep (p < .001); leisure pursuits (p=.02); quality of life (p=.007); abdominal swelling or cramps (p=.02); weight (p < .001); digest food (p=.04); appetite (p=.02); aches and pains (p=.007); diarrhea (p < .001); comfort level (p=.008); jaundice (p < .001); and pruritus (p < .001). There are more than 11 times as many significant differences than would be expected by chance alone. SUMMARY: Endoscopic stenting for MBDO resulted in improvements in physical well-being, emotional well-being and functional well-being. CONCLUSIONS: 1) Endoscopic stenting for MBDO (with relative indications for this therapy) appears justifiable based on a significant improvement in QOL. An analysis of the economic considerations of such a recommendation is necessary. 2) Identification of subsets of patients unlikely to have an improved QOL (example: patients unlikely to live > 30 days) is necessary. In the era of economic constraint, these patients should not be considered appropriate candidates for stenting. 3) This study is ongoing.
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging