Ignite Creation Date:
2024-05-05 @ 5:09 PM
Last Modification Date:
2024-10-26 @ 9:28 AM
Study NCT ID:
NCT00391183
Status:
COMPLETED
Last Update Posted:
2013-07-11
First Post:
2006-10-19
Brief Title:
Palliative Biliary Stenting on the Quality of Life of Patients With Unresectable Carcinoma Gallbladder With Hiliar Block
Sponsor:
All India Institute of Medical Sciences New Delhi
Organization:
All India Institute of Medical Sciences New Delhi
Study Overview
Official Title:
Effect of Palliative Biliary Stenting Versus Conservative Treatment on the Quality of Life QOL of Patients With Unresectable Carcinoma of the Gallbladder With Hiliar Block A Randomised Controlled Trial
Status:
COMPLETED
Status Verified Date:
2013-07
Last Known Status:
None
Delayed Posting:
No
If Stopped, Why?:
Not Stopped
Has Expanded Access:
False
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
None
Brief Summary:
The purpose of the study is to determine whether palliative biliary stenting improves the quality of life of gallblader cancer patients who present with hilar block and obstructive jaundice
Detailed Description:
For most patients with gallbladder cancer cure is not possible and treatment should be therefore aimed at palliation of symptoms and maintaining quality of life QOL in the few months between diagnosis and death Most of these patients suffer from intractable pruritis pain anorexia and general debility Biliary stenting leads to a reduction in pruritis and jaundice and is commonly offered to many unresectable patients However stenting related complications like cholangitis rescue percutaneous treatment and need for prolonged hospitalization often impair the remaining short survival of these patients In these patients improving the QOL should be the primary focus and survival a secondary end point in disease management No study has addressed the issue of QOL of patients with gallbladder cancer post stenting
Three clinical studies have evaluated the change in the QOL of patients with malignant biliary obstruction after of endoscopic stenting Ballinger et al evaluated 19 patients with unresectable pancreatic carcinoma before stenting and upto 12 weeks or death after stenting The Rotterdam Symptom Checklist and the Hospital Anxiety and Depression Scale were used Significant improvements were seen in the parameters of mood indigestion appetite and level of activity Luman et al studied 47 inoperable patients with malignant biliary strictures The European Organisation for Research and Treatment of Cancer QOL questionnaire EORTC QLQ-C30 was used at baseline and 1 month after stenting For patients successfully completing the follow up significant improvement in emotional cognitive and global health scores was found after stenting In addition to the expected improvement in pruritis and jaundice anorexia diarrhea and sleep pattern were also improved Abraham et al studied 50 patients with malignant biliary obstruction without liver metastasis considered non surgical candidates and undergoing palliative biliary stenting The SF-36 Health Survey Questionnaire was used to quantify QOL at baseline and 1 month after stent insertion Follow up data was available for only 26 patients Among these patients a significant reduction in the bilirubin level was associated with improvement in the social function and mental health A high baseline bilirubin 14mgdL was associated with a lack of improvement at 1 month follow up
Hence existing data regarding improvement in the QOL of patients undergoing palliative biliary stenting is sparce and incomplete Gallbladder cancer presenting a hilar block is the most common biliary malignancy in India Hilar tumors are associated with more technical failure of stenting higher cholangitis rates earlier stent blockage and shorter survival as compared to distal biliary tumors Only 6 patients with Klatskin tumors were included in one of the study8 Patients with hilar block were either not included6 or were not specified7 in the other studies
Health related quality of life QOL refers to the impact of a medical condition or its treatment on a persons expected physical psychological and social well being
Calman states that QOL evaluations measure the difference between the hopes and expectations of an individual and that individuals present experience
The multidimensionality that is commonly assessed in QOL measures includes
1 Physical symptoms of the disease or its treatment or concurrent illness
2 Functional capacity ability and energy for daily routine social interactions intellectual activity emotional reactions and adjustments economic independence
3 Self-perception of wellness or its absence There are two basic types of instruments for measuring the QOL generic and disease specific Generic instruments focus on the main components that constitute QOL and are intended to be applied in a wide range of populations and health states across all diseases There are many excellent validated self-completion questionnaires for cancer patients eg EORTC QOL questionnaire Functional assessment of Cancer Therapy FACT Rotterdam Symptom Checklist RSCL Functional Living Index Cancer FLIC All these questionnaires are multidimensional and it is rarely required to develop a new instrument
The EORTC QLQ-C30 has been developed in a multi-cultural setting and translations are available in 43 languages The instrument has been shown to be valid reliable and responsive to change Disease specific modules are available to supplement the core questionnaire Reference data is available for calculating sample size The questionnaire is easily understood by most patients and is quick to complete mean time 11 minutes
The EORTC QLQ-C30 is a 30- item questionnaire composed of multi-item scales and single items that reflects the multidimensionality of the quality of life construct It incorporates five functional scales physical role cognitive emotional and social three symptom scales fatigue pain nausea and vomiting and a global health and quality of life scale The remaining single items assess additional symptoms commonly reported by cancer patients dyspnea appetite loss sleep disturbance constipation and diarrhea as well as the perceived financial impact of the disease and its treatment The functional scales have 16 questions symptom scales have 6 questions global quality of life has two questions and there are six single item questions For ease of interpretation all scale and item scores are linearly transformed to a 0 to 100 scale For the 5 functional scales and the global quality of life scale a higher score represents a better level of functioning For the symptom oriented scales and items a higher score corresponds to a higher level of symptoms
Hence we plan to prospectively study unresectable gallbladder cancer patients with hilar block to evaluate whether palliative stenting improves their quality of life and whether the benefit afforded outweighs the early and late complications of stenting
Three clinical studies have evaluated the change in the QOL of patients with malignant biliary obstruction after of endoscopic stenting Ballinger et al evaluated 19 patients with unresectable pancreatic carcinoma before stenting and upto 12 weeks or death after stenting The Rotterdam Symptom Checklist and the Hospital Anxiety and Depression Scale were used Significant improvements were seen in the parameters of mood indigestion appetite and level of activity Luman et al studied 47 inoperable patients with malignant biliary strictures The European Organisation for Research and Treatment of Cancer QOL questionnaire EORTC QLQ-C30 was used at baseline and 1 month after stenting For patients successfully completing the follow up significant improvement in emotional cognitive and global health scores was found after stenting In addition to the expected improvement in pruritis and jaundice anorexia diarrhea and sleep pattern were also improved Abraham et al studied 50 patients with malignant biliary obstruction without liver metastasis considered non surgical candidates and undergoing palliative biliary stenting The SF-36 Health Survey Questionnaire was used to quantify QOL at baseline and 1 month after stent insertion Follow up data was available for only 26 patients Among these patients a significant reduction in the bilirubin level was associated with improvement in the social function and mental health A high baseline bilirubin 14mgdL was associated with a lack of improvement at 1 month follow up
Hence existing data regarding improvement in the QOL of patients undergoing palliative biliary stenting is sparce and incomplete Gallbladder cancer presenting a hilar block is the most common biliary malignancy in India Hilar tumors are associated with more technical failure of stenting higher cholangitis rates earlier stent blockage and shorter survival as compared to distal biliary tumors Only 6 patients with Klatskin tumors were included in one of the study8 Patients with hilar block were either not included6 or were not specified7 in the other studies
Health related quality of life QOL refers to the impact of a medical condition or its treatment on a persons expected physical psychological and social well being
Calman states that QOL evaluations measure the difference between the hopes and expectations of an individual and that individuals present experience
The multidimensionality that is commonly assessed in QOL measures includes
1 Physical symptoms of the disease or its treatment or concurrent illness
2 Functional capacity ability and energy for daily routine social interactions intellectual activity emotional reactions and adjustments economic independence
3 Self-perception of wellness or its absence There are two basic types of instruments for measuring the QOL generic and disease specific Generic instruments focus on the main components that constitute QOL and are intended to be applied in a wide range of populations and health states across all diseases There are many excellent validated self-completion questionnaires for cancer patients eg EORTC QOL questionnaire Functional assessment of Cancer Therapy FACT Rotterdam Symptom Checklist RSCL Functional Living Index Cancer FLIC All these questionnaires are multidimensional and it is rarely required to develop a new instrument
The EORTC QLQ-C30 has been developed in a multi-cultural setting and translations are available in 43 languages The instrument has been shown to be valid reliable and responsive to change Disease specific modules are available to supplement the core questionnaire Reference data is available for calculating sample size The questionnaire is easily understood by most patients and is quick to complete mean time 11 minutes
The EORTC QLQ-C30 is a 30- item questionnaire composed of multi-item scales and single items that reflects the multidimensionality of the quality of life construct It incorporates five functional scales physical role cognitive emotional and social three symptom scales fatigue pain nausea and vomiting and a global health and quality of life scale The remaining single items assess additional symptoms commonly reported by cancer patients dyspnea appetite loss sleep disturbance constipation and diarrhea as well as the perceived financial impact of the disease and its treatment The functional scales have 16 questions symptom scales have 6 questions global quality of life has two questions and there are six single item questions For ease of interpretation all scale and item scores are linearly transformed to a 0 to 100 scale For the 5 functional scales and the global quality of life scale a higher score represents a better level of functioning For the symptom oriented scales and items a higher score corresponds to a higher level of symptoms
Hence we plan to prospectively study unresectable gallbladder cancer patients with hilar block to evaluate whether palliative stenting improves their quality of life and whether the benefit afforded outweighs the early and late complications of stenting
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
None
Is a FDA Regulated Device?:
None
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
None
Is an FDA AA801 Violation?:
None