To the Editor:
Dr. Huang et al. 1 should be congratulated for their evaluation of the quality of life (QOL) in pancreaticoduodenectomy survivors. For this study, they used a QOL tool developed at our institution looking at the overall physical, psychological, and social domains. In addition to these QOL domains, we feel that the spiritual domain is an important component of the tool. 2 The overall QOL scores were high, and compared favorably to patients who underwent a laparoscopic cholecystectomy and healthy controls. In subgroup analysis, they show the chronic pancreatitis and pancreatic adenocarcinoma patients may rate their QOL lower than other groups, especially related to such outcomes as abdominal pain, thirst, foul stools, and diabetes. Therefore surgeons may need to focus their efforts on these QOL concerns.
We have recently used a similar tool to assess QOL related to patients with intestinal stomas. A mailed survey to 1,600 respondents resulted in 43% colostomy patients, 40% ileostomy patients, and 17% urinary diversion patients. In subgroup analysis of cancer versus noncancer patients with colostomies, cancer patients reported a better overall QOL for each domain except for spirituality, where both groups were similar. In addition, problem areas such as sexual function, dietary adaptations, travel, and body image were identified. Individual or group counseling was seen to be important for most colostomy patients. Therefore, as with Dr. Huang’s study, groups of patients can be identified where early interventions can potentially improve QOL parameters. We are also examining outcomes for ileostomy and urinary diversion patients to identify problem areas.
Finally, we are looking at QOL as related to palliative procedures for cancer patients. For this effort, we are attempting to assess how surgical interventions can impact end of life care. Therefore, we are agree that studies such as those conducted at the John Hopkins Medical Center are extremely important in helping to define the role of surgery and improve QOL outcomes.
Robert S. Krouse, MD*
David ZJ Chu, MD†
Marcia Grant, DNSc†
Betty Ferrell, PhD†
Lawrence D. Wagman, MD†
References
- 1.Huang JJ, Yeo CJ, Sohn TA et al. Quality of life outcomes after pancreaticoduodenectomy. Ann Surg 2000; 231: 890–898. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Ferrell BR, Hassey Dow K, Grant M. Measurement of the quality of life in cancer survivors. Quality of Life Res 1995; 4: 523–531. [DOI] [PubMed] [Google Scholar]