Validation of the EORTC QLQ-BIL21 questionnaire for measuring quality of life in patients with cholangiocarcinoma and cancer of the gallbladder.

BACKGROUND: There is no specific quality of life (QoL) measurement tool to quantify QoL in patients with biliary tract cancer. Quality of life measurement is an increasingly crucial trial end point and is now being incorporated into clinical practice. METHODS: This International Multicentre Phase IV Validation Study assessed the QLQ-BIL21 module in 172 patients with cholangiocarcinoma and 91 patients with cancer of the gallbladder. Patients completed the questionnaire at baseline pretherapy and subsequently at 2 months. Following this, the psychometric properties of reliability, validity, scale structure and responsiveness to change were analysed. RESULTS: Analysis of the QLQ-BIL21 scales showed appropriate reliability with Cronbach's α-coefficients >0.70 for all scales overall. Intraclass correlations exceeded 0.80 for all scales. Convergent validity >0.40 was demonstrated for all items within scales, and discriminant validity was confirmed with values <0.70 for all scales compared with each other. Scale scores changed in accordance with Karnofsky performance status and in response to clinical change. CONCLUSIONS: The QLQ-BIL21 is a valid tool for the assessment of QoL in patients with cholangiocarcinoma and cancer of the gallbladder.

Quality of life across chemotherapy lines in patients with cancers of the pancreas and biliary tract.

BACKGROUND: In patients with cancers of the pancreatic and biliary tract quality of life (QOL) improvement is the main treatment goal, since survival can be prolonged only marginally. Up to date, knowledge on QOL impairments throughout the entire treatment process, often including several chemotherapy lines, is scarce. Our study aimed at investigating QOL trajectories from adjuvant treatment to palliative 3rd-line therapy METHODS: Patients were included in routine electronic patient-reported outcome monitoring at Kufstein County Hospital at the time of diagnosis and assessed with the EORTC QLQ-C30 during each chemotherapy cycle. RESULTS: Eighty out of 147 patients with pancreatic cancer or cancer of the bile ducts treated at the Kufstein County Hospital, fulfilled inclusion criteria and could be included in the study (mean age 67.4 years; 53.8% women). Physical, Emotional and Cognitive Functioning, and Global QOL deteriorated across chemotherapy lines, whereas Fatigue, Pain, Dyspnoea, Sleeping Disturbances, Diarrhoea, and Taste Alterations increased. With regard to Physical Functioning, Global QOL, Fatigue, Dyspnoea, Diarrhoea and Taste Alterations, the patients receiving adjuvant or 1st-line palliative chemotherapy did not differ significantly. Most patients in 2nd- or 3rd-line chemotherapy showed significantly higher impairments and symptom burden. However, patients under 1st and 2nd-line treatment showed stable QOL trajectories, whereas 3rd-line patients perceived substantial deteriorations. CONCLUSIONS: The results suggest early palliative treatment initiation to stabilise QOL on a level as high as possible. The continuous QOL improvement during adjuvant treatment, probably reflecting post-operative recovery, may indicate that deleterious effects of adjuvant chemotherapy on QOL are highly unlikely.

Development of a questionnaire (EORTC module) to measure quality of life in patients with cholangiocarcinoma and gallbladder cancer, the EORTC QLQ-BIL21.

BACKGROUND: Quality of life measurement in cholangiocarcinoma and gallbladder cancer involves the assessment of patient-reported issues related to the symptoms, disease and treatment of these tumours. This study describes the development of the disease-specific quality of life (QoL) questionnaire for patients with cholangiocarcinoma and gallbladder cancer to supplement the European Organization for Research and Treatment of Cancer (EORTC)-QLQ C30 core cancer questionnaire. METHODS: Phases 1-3 of the guidelines for module development published by the EORTC were followed, with adaptations for incorporation of questions from existing modules. RESULTS: A total of 47 QoL issues (questions) were identified; 44 questions from the two related validated questionnaires, the EORTC QLQ-PAN26 (pancreatic module) and the EORTC QLQ-LMC21 (liver metastases module), two from the Functional Assessment of Cancer Therapy hepatobiliary module questionnaire in the literature search and one from healthcare professional interviews. Following phase 1 and 2 interviews with patients (n=101) and health care professionals (n=6), a 23-question provisional questionnaire was formulated. There were five questions from PAN26, 15 from LMC21 and three extra questions. In phase 3, the provisional item list was pre-tested in 52 patients in four languages and this resulted in a 21-item module. CONCLUSION: This is the only disease-specific QoL questionnaire for patients with cholangiocarcinoma and gallbladder cancer, and initial assessments show it to be accurate and acceptable to patients in reflecting QoL in these diseases.

The loneliness of fighting a rare cancer.

After her mother is diagnosed with gallbladder cancer, a journalist researches how to help find effective therapies for patients who get rare diseases.

Cáncer de vesícula: manejo del dolor y otros síntomas / Gallbladder cancer: pain and other symptoms management

El cáncer de vesícula es generalmente diagnosticado tardíamente, por lo cual manejar adecuadamente los síntomas y optimizar la calidad de vida es fundamental. El dolor es generalmente de origen visceral y en su manejo se privilegia la vía oral y subcutánea, según el concepto de escalera analgésica de la OMS; esto facilita el acceso de los pacientes a la analgesia opioide y a los fármacos coadyuvantes. Los métodos invasivos son: analgesia espinal y bloqueo neurolítico de plexo celíaco.Otros síntomas como náuseas y vómitos, anorexia, astenia, constipación, ictericia y prurito, edema de extremidades, ascitis, singulto y cuadros ansioso-depresivos, se tratan con diversas estrategias farmacológicas y no farmacológicas. La atención de los problemas psicosociales del paciente y su familia es también muy importante. En la experiencia del Instituto Nacional del Cáncer entre 1994 y 2001, se observa un incremento progresivo de los pacientes con cáncer de vesícula avanzado, describiéndose la incidencia, evolución y tratamiento de 120 pacientes con distintos síntomas de una patología cuya sobrevida fue entre 1 y 224 días (promedio 49.8 días) y en los cuales se aplicó un modelo de manejo integral del paciente, bajo el concepto de medicina paliativa.

Gallbladder cancer is diagnosed too late most of the time. For this reason symptomatic management and improve quality of life is essential. Pain has visceral origin and must be alleviated using the WHO analgesic ladder strategy by oral or subcutaneous route. Access of patient to different opioids and coadyuvants is mandatory. Invasive methods for analgesia includes spinal analgesia and neurolityc celiac plexus block. Other symptoms like nausea and vomits, anorexia, asthenia, constipation, jaundice and pruritus, lower limbs oedema, ascites, hiccup, and depressive states, need pharmacological and non pharmacological approach. Psychosocial intervention is advisable. Analysing "Instituto Nacional del Cáncer" experience since 1994 to 2001, a progressive increment in patients with gallbladder cancer is observed, describing the incidence, evolution and management of pain and others symptoms in 120 patients with this pathology. Mean survival of patients was between 1 and 224 days, (mean 49,8 days). An integral management of palliative medicine was applied.

Hepatopancreatoduodenectomy for advanced gallbladder carcinoma.

OBJECTIVE: To assess the effectiveness of hepatopancreatoduodenectomy (HPD) in patients with advanced gallbladder carcinoma directly invading the liver and pancreas, generally considered to be nonresectable. PATIENTS AND METHODS: Sixty patients with gallbladder carcinoma admitted to our hospital from 1978 to 1992, of whom 55 had Nevin stage V carcinoma and 21 had resectable tumors. Of these patients, seven underwent HPD. The remaining 34 patients had nonresectable tumors. The outcomes of patients undergoing HPD and those with nonresectable tumors were compared and the effect on their quality of life was also analyzed. RESULTS: Postoperative complications occurred in five of the seven patients after HPD, but there were no operative deaths. The 1- and 2-year survival rates were 57% and 28.6%, respectively, with a median survival time of 12 months. In contrast, the 1- and 2-year survival rates of the 34 patients with nonresectable tumors were both 5.8%, and the median survival time was 2 months. The median and mean durations of home stay after HPD were 6 and 10.5 months, respectively. CONCLUSION: Hepatopancreatoduodenectomy has the potential to improve both survival and the quality of life for carefully selected patients with advanced gallbladder carcinoma.