Transhiatal vs extended transthoracic resection in oesophageal carcinoma: patients' utilities and treatment preferences

Abstract

To assess patients' utilities for health state outcomes after transhiatal or transthoracic oesophagectomy for oesophageal cancer and to investigate the patients' treatment preferences for either procedure. The study group consisted of 48 patients who had undergone either transhiatal or transthoracic oesophagectomy. In an interview they were presented with eight possible health states following oesophagectomy. Visual Analogue Scale and standard gamble techniques were used to measure utilities. Treatment preference for either transhiatal or transthoracic oesophagectomy was assessed. Highest scores were found for the patients' own current health state (Visual Analogue Scale: 0.77; standard gamble: 0.97). Lowest scores were elicited for the health state ‘irresectable tumour’ (Visual Analogue Scale: 0.13; standard gamble: 0.34). The Visual Analogue Scale method produced lower estimates ( P <0.001) than the standard gamble method for all health states. Most patient characteristics and clinical factors did not correlate with the utilities. Ninety-five per cent of patients who underwent a transthoracic procedure and 52% of patients who underwent a transhiatal resection would prefer the transthoracic treatment. No significant associations between any patient characteristics or clinical characteristics and treatment preference were found. Utilities after transhiatal or transthoracic oesophagectomy were robust because they generally did not vary by patient or clinical characteristics. Overall, most patients preferred the transthoracic procedure. British Journal of Cancer (2002) 86 , 851–857. DOI: 10.1038/sj/bjc/6600203 www.bjcancer.com © 2002 Cancer Research UK

Quality of Life in Patients with Oesophageal and Gastric Cancer: An Overview

“…Mortality rates vary between 1 and 8% and major morbidity occurs in almost 50% of the patients undergoing resection [32, 33]. The impact of surgery on QoL has been investigated in several prospective studies using validated reliable questionnaires [22, 34, 35].…”

Effects of prolonged intensive care unit stay on quality of life and long-term survival after transthoracic esophageal resection

“…On the other hand, transthoracic esophagectomy led to significantly higher early pulmonary morbidity, higher costs, and a longer stay in the ICU. When analyzing patients' treatment preferences, De Boer et al (4) concluded that most patients preferred the transthoracic procedure over the transhiatal procedure. Apparently, the patients were prepared to undergo a more demanding procedure to optimize their chances for definite cure from this malignant disease (4).…”

“…Postoperative morbidity and mortality rates are substantial, and almost all patients stay in the ICU postoperatively. Due to the magnitude of the operation, physical, emotional, and social effects are large, with potentially serious consequences for short-term and longterm QoL (3,4). Because of these serious consequences and because of the limited survival after an esophagectomy, information about the expected postoperative QoL could be an important factor in future approaches toward different patients with esophageal cancer (5).…”

A Systematic Review to Identify the Use of Preference Elicitation Methods in Healthcare Decision Making

“…It is compositional, and the weights are drawn up directly. Our review identified 42 studies using direct choice questions in one form or another, ranging from questionnaires consisting only of direct choice questions [40] to studies using direct choice as an additional method-for example, with a VAS [41].…”