Assessment of quality of life in inoperable malignant dysphagia: A review of patients' perception of palliative treatment.

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Esophageal carcinoma is one of the most common cancers in the world and is a major cause of morbidity and death in the United States. Surgery has curative potential in a proportion of patients with esophageal cancer, but is associated with a high rate of morbidity and mortality even in specialized centers. Once recurrent most treatment goals related to these patients will be palliative in nature, and quality of life (QOL) assessment is crucial for the evaluation of health care outcome. The objective of this study was to review the different methods used in reported investigations on the physical and psychosocial correlates of palliative treatment of esophageal cancer during the last ten years. One hundred and eighty one reports searched in PubMed on palliative treatment and quality of life in esophageal cancer patients were reviewed. Four QOL instruments were identified and evaluated with respect to definitions, measurement and findings. Analysis reveals that no one instrument was ideal for assessing palliative intervention for head and neck cancer. However, the EORTC (European Organization for Research and Treatment of Cancer), and the SF36 were the most frequently used on the published reports. Despite a growing awareness and interest in QOL of esophageal cancer patients as seen in more recent prospective studies, definitive validation of patient assessment to date has been limited in scope with both problems and promise seen in most reports. In general, palliative longitudinal studies are almost non-existent with little known about the impact or comorbidity of smoking and alcohol use upon the disease progression and correlation with QOL.