1. CHANGING PRIORITIES

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

3. 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

4. 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

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

6. 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%

7. 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

8. 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.