CHANGING PRIORITIES

CURRRENT INCURABILITY OF OESOPHAGEO-GASTRIC CANCER 50-80% of oesophageal cancer patients are incurable @ diagnosis 29-52% of gastric cancer patients are incurable @ diagnosis Changing Priorities

CONVENTIONAL END POINTS OF CLINICAL TRIALS IN CANCER Technical success rate   Morbidity Mortality Length of stay Complete or partial response Survival (and hospital-free survival) Changing Priorities

QUALITY OF LIFE IN INCURABLE CANCER PATIENTS More important to patients and carers   Treatment-related morbidity must be kept low Maximises hospital-free survival Needs validated measurement tools Changing Priorities

VALIDATED QUALITY OF LIFE TOOLS Similarities Among QOL Questionnaires EORTC SF-36 PLC FACT TECHNICAL ASPECTS Likert-Scaling X Self-assessed Length: approx 30-40 items CONTENTS Somatic symptoms (X) Psychological well-being Social aspects Functional capabilities Global QOL Dunn & Johnson,2004

VALIDATED QUALITY OF LIFE TOOLS Differences between QOL questionnaires Dunn & Johnson, 2004 EORTC SF-36 PLC FACT TECHNICAL ASPECTS Scaling (response options) 4, 7 2, 3, 5, 6 5 Self and other ratings NO YES Short version Time period (past …) 7 days 7 days or 4 weeks Translations (no of language) > 20 3 CONTENTS Somatic symptoms 27% 6% (0%) 25% Psychological well-being 13% 33% 29% Social aspects 10% 23% 39% Functional capabilities 50%   53% 32% Global QOL 7% 0% 100% Positive experiences 3% 14% 45% 43% Negative experiences (complaints, impairments) 97% 72%

COMORBIDITY & PERFORMANCE STATUS Validated performance scales -WHO, KARNOFSKY, ASA, ECOG Within each cancer stage, survival is related to PS GOOD PS POOR PS SIGNIFICANCE INTERVENT. MORBIDITY 50% P<0.03 TREATMENT EFFICACY 71% 14% P<0.01 MEDIAN SURVIVAL 161 days 24 days P<0.0003 ALEXANDER 1994

D Studies of treatments in patients with incurable upper GI cancer should use validated questionnaires to measure quality of life outcomes and should include co-morbidity and performance status.    Quality of life assessment should become an essential component of routine clinical practice in the palliative care setting.