Survival and quality of life in gastrointestinal tumors: two different end points?
BACKGROUND
In gastrointestinal tumors, the traditional end point of medical treatment was represented mainly by survival. In the last few years, however, there has been an increasing awareness about the role of quality of life.


METHODS
This paper seeks to discuss these two important end points and their relationship in colorectal, gastric, pancreatic and liver cancers.


RESULTS
Chemotherapy has doubled survival in comparison with best supportive care in gastrointestinal tumors. A subjective response, represented by a decrease in cancer-related symptoms is expected in about half of the symptomatic patients in colorectal and gastric cancer. In pancreatic cancer, the positive results in terms of clinical benefit helped define the role of chemotherapy. Although clinical benefit does not represent a validated tool to measure quality of life, it can be a first step in the definition of new, simpler tools to assess this end point. The frequent presence of a serious concomitant disease, liver cirrhosis, in patients with hepatocellular carcinoma (HCC) usually prevents the use of chemotherapy in these tumors, which are often treated with locoregional treatments. Unfortunately, their impact on the survival and quality of life of these patients has never been adequately assessed.


CONCLUSIONS
In many gastrointestinal cancers, chemotherapy can produce a survival gain and an improvement in the quality of life. Further studies assessing new drugs and/or combinations should focus on these aspects and their relationships. In particular, the impact of treatments of HCC on both survival and quality of life must be investigated by well-designed prospective trials. When assessing the value of a particular anticancer treatment, it is important to consider the impact it may have not only on survival but also on quality of life. This is particularly so for cancer patients, whose life expectancy may be short.
Cascinu
S
S
Medical Department, Azienda Ospedaliera di Parma, Italy. cascinu@yahoo.com
Labianca
R
R
Daniele
B
B
Beretta
G
G
Salvagni
S
S
D006528:Carcinoma, Hepatocellular / Q000188:drug therapy / Q000401:mortality / Q000523:psychology*; D004359:Drug Therapy, Combination; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000523:psychology*; D016031:Liver Transplantation; D017063:Outcome Assessment, Health Care; D010190:Pancreatic Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000523:psychology*; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D013274:Stomach Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000523:psychology*