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      Comparison of Quality of Life in Patients Undergoing Transhiatal Esophagectomy with or without Chemotherapy

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          Abstract

          Background/Aim:

          To compare the quality of life (QOL) in patients undergoing transhiatal esophagectomy (THE) with or without chemotherapy, who were admitted to the Post Graduate Institute of Medical Education and Research, Chandigarh and enrolled in the study, from July 2004 to October 2005.

          Patients and Methods:

          Thirty patients of esophageal carcinoma by purposive sampling were randomized into two groups i.e., patients undergoing THE after chemotherapy and patients undergoing THE without chemotherapy. Two QOL questionnaires, one generic i.e., EORTC-QLQ C-30 (European Organization for Research and Treatment of Cancer) and other esophageal cancer-specific i.e., EORTC OES-18 were utilized to assess the QOL.

          Result:

          Physical functional scales were better in patients, who received neoadjuvant chemotherapy. The role and social aspects of functional scales deteriorated after completion of treatment in both groups. This was primarily due to the effect of surgery. However, they were better from an emotional and cognitive point of value after surgery and radiotherapy. Fourteen out of 30 patients experienced vomiting and diarrhea due to radiotherapy.

          Conclusion:

          THE in esophageal carcinoma improves global health scales and majority of symptom scales in all patients. QOL improvement in general was better in patients who were administered neoadjuvant chemotherapy along with surgery.

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          Most cited references15

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          Surgical resection with or without preoperative chemotherapy in oesophageal cancer: a randomised controlled trial.

          (2002)
          The outlook for patients with oesophageal cancer undergoing surgical resection with curative intent is poor. We aimed to assess the effects of preoperative chemotherapy on survival, dysphagia, and performance status in this group of patients. 802 previously untreated patients with resectable oesophageal cancer of any cell type were randomly allocated either two 4-day cycles, 3 weeks apart, of cisplatin 80 mg/m(2) by infusion over 4 h plus fluorouracil 1000 mg/m(2) daily by continuous infusion for 4 days followed by surgical resection (CS group, n=400), or resection alone (S group, 402). Clinicians could choose to give preoperative radiotherapy to all their patients irrespective of randomisation. Primary outcome measure was survival time. Analysis was by intention to treat. No patients dropped out of the study. Resection was microscopically complete in 233 (60%) of 390 assessable CS patients and 215 (54%) of 397 S patients (p<0.0001). Postoperative complications were reported in 146 (41%) CS and 161 (42%) S patients. Overall survival was better in the CS group (hazard ratio 0.79; 95% CI 0.67-0.93; p=0.004). Median survival was 512 days (16.8 months) in the CS group compared with 405 days (13.3 months) in the S group (difference 107 days; 95% CI 30-196), and 2-year survival rates were 43% and 34% (difference 9%; 3-14). Two cycles of preoperative cisplatin and fluorouracil improve survival without additional serious adverse events in the treatment of patients with resectable oesophageal cancer.
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            The problem of quality of life in medicine.

            The use of the term "quality of life" to encompass the values and perceptions of patients has created doubt, confusion, and misunderstanding among practitioners, researchers, policymakers, and patients. The principal reason for this state of affairs is that a clear conceptual basis for quality-of-life measures is lacking. In this article, the current rationale for quality-of-life measurement in the health field is examined, and the drawbacks of the various models being used are outlined. Our suggestion is that quality of life as an outcome could be explored more clearly (ie, defined) if quality of life were replaced with a more easily handled notion such as that of "subjective health status." However, the idea that the patient's perspective is as valid as that of the clinician when it comes to evaluating outcomes has a great deal of legitimacy and should certainly not be abandoned.
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              Surgical therapy of oesophageal carcinoma.

              During the past 10 years, postoperative mortality associated with surgical treatment of oesophageal carcinoma has been reduced by one-half. However, it appears that all efforts to improve long-term survival with extensive excisional procedures and adjuvant chemotherapy and radiotherapy have failed. Fifty-six of 100 patients presenting to the surgeon with an oesophageal carcinoma have resectable disease. Recent studies suggest that seven of them will die from postoperative complications and 49 patients will be discharged from the hospital after an average of 3 weeks. Of these patients, 27 will survive the first, 12 the second, and ten the fifth year. Although it may be possible to further reduce postoperative complications and mortality, the chances of improving the long-term prognosis of patients with oesophageal carcinoma seem small.
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                Author and article information

                Journal
                Saudi J Gastroenterol
                Saudi J Gastroenterol
                SJG
                Saudi Journal of Gastroenterology : Official Journal of the Saudi Gastroenterology Association
                Medknow Publications & Media Pvt Ltd (India )
                1319-3767
                1998-4049
                May-Jun 2012
                : 18
                : 3
                : 195-200
                Affiliations
                [1]Department of Surgical Discipline, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
                [1 ]Department of Surgery, PGIMER, Chandigarh, India
                [2 ]Department of Psychiatry, PGIMER, Chandigarh, India
                [3 ]Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
                Author notes
                Address for correspondence: Dr. Kamal Kataria, Department of Surgical Discipline, All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110 029, India. E-mail: drkamalkataria@ 123456gmail.com
                Article
                SJG-18-195
                10.4103/1319-3767.96454
                3371422
                22626799
                641d7b1e-7b79-44e3-9ff9-39537236d9d1
                Copyright: © Saudi Journal of Gastroenterology

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 12 September 2011
                : 29 November 2011
                Categories
                Original Article

                Gastroenterology & Hepatology
                transhiatal,neoadjuvant,quality of life,functional scale,global health scale,esophagectomy

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