Quality of life in patients with esophageal stenting for the palliation of malignant dysphagia

Table 1 Examples of quality of life questionnaires used to assess quality of life in patients with esophageal cancer

Category	Type of questionnaire	Advantages	Disadvantages
Generic	SF-36	Good psychometric properties
	EQ-5D	Reliable	Limited number of domains
Cancer-specific	Spitzer QoL index	Brief and easy to complete	Limited number of domains
			Ceiling effect
	EORTC QLQ C30	Fully validated	Site-specific modules may add to patient burden
		The most widely used specific instrument
		Clinical significance assessed
	HAD scale	Well validated and widely used with RSCL	Only assesses anxiety and depression
EC-specific	EORTC QLQ-OES18	Fully validated	Needs to be used with QLQ-C30
	EORTC QLQ-STO22	Fully validated	Limited supporting psychometric data
	FACT-E	Provides overall summary score

Modified from Conroy et al[55]. SF-36: Medical Outcomes Study 36-Item Short Form Health Survey; HAD: Hospital Anxiety and Depression; QoL: Quality of life; EORTC QLQ: European Organization for Research and Treatment QoL Questionnaire; FACT: Functional Assessment of Cancer Therapy.

Table 2 Characteristics of conventional and anti-reflux mechanism self-expanding metal stents

	Material	Length	Inner diameter	Constrainability	Foreshortening	Anti-reflux mechanism
Conventional SEMS
Ultraflex	Nitinol	10 cm (7 cm CS)	18 mm with 23 mm PF	Braided nylon wire	20% to 40%
	Polyurethane sheath	12 cm (9 cm CS)	23 mm with 28 mm PF	Not reconstrainable when partially deployed
		15 cm (12 cm CS)
Z stent	Stainless steel	8, 10, 12, 14 cm	18 mm with 25 mm PF and DF	Polyethylene sheath	None
	Polyurethane covering			Reconstrainable when partially deployed
Wallstent	Elgiloy	10 cm (8 cm CS)	20 mm with 23 mm PF and DF	Polyethylene sheath	Up to 28%
	Polyurethane sheath	15 cm (13 cm CS)		Reconstrainable when
				partially deployed
SEMS with an anti-reflux mechanism
Dua Z-stent						Polyurethane sleeve (collapses with gastric pressure)
DO stent						Tricuspid valve
Fer-X-Ella stent						Stainless steel with polyethylene covering and windsock type valve

Modified from Sreedharan et al[56]. SEMS: Self-expanding metal stents; CS: Covered segment; PF: Proximal flare; DF: Distal flare.

Table 3 Quality of life results after self-expanding metal stents placement for malignant dysphagia

Ref.	Yr	Study type	Investigation	Type of questionnaire	Results
Dallal et al[52]	2001	Randomized trial	Endoscopic thermal ablation vs SEMS in patients with inoperable EC	EORTC QLQ-30	HRQoL deteriorated in the stent group but not in the group treated with thermal ablation
				EORTC OES-24
				SF-36
				HAD scale
Siersema et al[53]	2001	Prospective, randomized study	comparison between Ultraflex stent, Flamingo Wallstent, and Gianturco-Z stent in 100 consecutive patients with dysphagia caused by EC or carcinoma of the gastric cardia	WHO performance status	Mean WHO performance status before and at 4 wk after stent placement was not different among the 3 patient groups
				Dysphagia score
O'Donnell et al[48]	2002	Randomized clinical trial	SEMS vs plastic endoprostheses	EORTC QLQ-30	QoL in patients with SEMS was better than in plastic stents (no statistical significance)
				EORTC OES-24
Homs et al[51]	2004	Randomized trial	Stent placement vs single dose brachytherapy for the palliation of EC	EORTC OES-23	Treatment with single dose brachytherapy gave better overall scores on HRQoL scales compared with stent placement for the palliation of EC
				Visual analogue pain scale
				EORTC QLQ-C30
				Euroqol EQ-5D
				EQ-VAS
Shenfine et al[49]	2005	Randomized controlled trial	Cost-effectiveness of palliative therapies for patients with inoperable EC	Spitzer QoL index	Mean QoL index for the SEMS group at 6 wk was significantly lower than the QoL index at baseline for the same group
				Karnowsky performance scale
				Euroqol EQ-5D
				EORTC QLQ-30
Bergquist et al[50]	2005	Randomized controlled clinical trial	Endoluminal brachytherapy vs endoscopic stent placement in patients with advanced EC or gastroesophageal junction cancer	EORTC OES-23	Insertion of SEMS offered a more instant relief of dysphagia compared to endoluminal brachytherapy, but HRQoL was more stable in brachytherapy treatment
				EORTC QLQ-30
Madhusudhan et al[54]	2009	Prospective study	QoL after palliative stenting in patients with inoperable EC	EORTC QLQ-C30	Palliative stenting using SEMS resulted in significant improvement in all scales of QoL
				EORTC QLQ-OES 18

QoL: Quality of life; HRQoL: Health-related quality of life; EC: Esophageal cancer; SEMS: Self-expanding metal stents.