ESOPHAGEAL STENTING FOR ESOPHAGOGASTRIC CANCER PALLIATION: HOW TO PROSPECTIVELY EVALUATE QUALITY OF LIFE?

Aims Esophageal stents have a well-established role in the palliation of esophageal and esophagogastric cancers. However, there is little prospective data on the impact of esophageal stenting in patients’ quality of life (QoL). Our aim was to evaluate the feasibility of a web-based app to assess the impact of esophageal stenting in the QoL of patients with esophageal malignancy.

Methods Prospective study from August 2017 to October 2019. Three validated questionnaires (EORTC-QLQ-C30, QLQ-OES18 and QLQ-OG25) were incorporated in a smartphone app. Questionnaires were applied to esophagogastric cancer patients before stent placement (baseline) and at three moments after stenting (30, 90 and 180 days), directly through a smartphone app or during a nursing phone consultation. Answers were wirelessly transmitted.

Results Eighty esophageal or esophagogastric stents were placed in 72 patients, with an immediate success rate of 100% and no immediate adverse events. Ten patients died at 30 days. Sixty-eight patients (94%) answered the baseline QoL questionnaire, 23 at 30 days, 12 at 90 days and 4 at 180 days. We included 23 patients for QoL analysis at 30 days post-stenting: 23 for global health status (QLQ-30) and 15 for esophageal symptoms (QLQ-OES18). There was a significant improvement in swallowing saliva (mean score 44 vs 73, p=0.017) and constipation (mean score 55 vs 86, p=0.015) and a tendency for dysphagia improvement (37 vs 61, p=0.05) There was a mean score improvement >10 points in global health status, although not statistically significant.

Conclusions QoL assessment is paramount to evaluate the effectiveness of endoscopic palliative techniques. In this study, prospective QoL evaluation of stent palliation for esophageal malignancy was feasible and consistent with an improvement in QoL. The main constraint was to abstain from involving health professionals during the follow-up.