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 stenting 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. We previously reported (GIE 1996;43:321A) that endoscopic stenting for MBDO was associated with significant improvements in physical well-being, emotional well-being, and functional well-being 30 days following stent placement. The aim of this study was to determine whether these results persist during long-term follow-up. 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. 110 patients with MBDO filled out the questionnaire prior to biliary stenting and 30 days following stent placement The subjects of this study are the 47 patients who were still alive and filled out the questionnaire 6 months after stent placement. The results at 6 months were compared to pre-stenting using paired T-tests. RESULTS: Endoscopic biliary stenting resulted in a statistically significant improvement in nausea (p=.018); meeting family needs (p=.03); feeling of well-being (p<.001); time spent in bed (p<.001); sex life (p=.03); nervousness (p<001); sadness (p=.001); coping with illness (p=.02); fear of dying (p=.004); ability to work (p<01); fulfillment from work (p=.005); enjoy life (p<.001); acceptance of illness (p=.005); sleep (p<.001); leisure pursuits (p<.001); quality of life (p=.001); weight (p=.006); digest food (p=.017); appetite (p=.005); jaundice (p=.003); and pruritus (p<.001). There are more than 10 times as many significant differences than would be expected by chance alone. SUMMARY: Endoscopic stenting for MBDO resulted in long-term improvements in physical well-being, social well-being, emotional well-being and functional well-being. CONCLUSIONS: 1) Endoscopic stenting for MBDO appears justifiable based on a significant long-term 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.
|Original language||English (US)|
|State||Published - Dec 1 1997|
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging