Health related quality of life assessment in post-operative oesophageal cancer patients

G Jayasinghe, BSc, MBBS, MRCS, M Aboul Enein, MBChB, MSc, MRCS, A Hamouda, MD, FRCS, A Nisar, FRCS, H Ali, MD, FRCS. Maidstone and Tunbridge Wells Hospital -NHS trust.

INTRODUCTION-Surgical treatments for gastrointestinal malignancies are well documented to have a significant impact on the quality of life for patients. The functional Assessment of Cancer Therapy-General scale (Fact-G) is a validated universal tool developed to assess Health related quality of life outcome in cancer patients. The FACT-G focuses on the domains of personal well being, social/family well being, emotional well being and functional well being. The aim of this study was to assess the outcomes of post oesophagecomy patients from a district general hospital in the United Kingdom.

METHODS AND PROCEDURES-The FACT-G questionnaire was sent to the 60 patients who underwent oesophagectomies between 2006 and 2011. All patients were greater than 2 years post oesophagectomy. The returned questionnaires were analysed to determine the quality of life in patients post procedure and compared to the normative FACT-G data obtained from 1075 subjects from the normal U.S population. Missing items within the scale were calculated prorata which has been a successfully validated method if greater than 80% of the items have been answered.

RESULTS-From the 60 FACT-G questionnaires posted 47 were returned, 3 patients from the sample had died yielding a 83.3% response rate. A total of 1218 individual items were answered from 1269 (4.0 % missing items). Total FACT G score was 78.7 from a possible 108 S.D 20.1. Mean ratings for patients within each domain were; personal well being 20.0 from 28 S.D 6.8, social/family well being 21.3 from 28 S.D 7.1, emotional well being 18.6 from 24 S.D 4.8 and functional well being 18.7 from 28 S.D 6.8.

The students t-test was used to compared to the normative data and returned scales. There was no significant differences in mean (confidence interval 95%) between the Total FACT G; t= -0.4 (p=0.32), emotional well being; t=-1.81 (p=0.038), functional well being; t=0.19 (p=0.5). Differences in means between personal wellbeing and social well being were noted, t=-2.68 (p=0.005) and t= 2.56 (p=0.99) respectively

CONCLUSIONS-Data shows no significant difference between the normal population and post operative oesophagectomy patients in the domains of emotional and functional well being. There was a statistical difference between the subjects and population means in the social/family wellbeing domain. However the social/family well being among post operative patients was higher than that of the normative population data indicating a possible higher level of social support for these patients. Subjects reported greatest satisfaction in emotional well being possibly indicating a psychological boost these patients receive from an improved prognosis. Post operative patients reported least satisfaction in the functional domain. Studies have associated a higher FACT-G score with prolonged survival rates and reduced morbidity rates. More in depth studies are needed to determine why patients report more positively in some domains than rather than others and the reasons why emotional well being in post operative oesophagectomy patients is greater than that of the normal population.

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