ABSTRACT
Photodynamic therapy was the first treatment to have been shown to significantly decrease high-grade dysplasia and cancer in patients with Barrett's esophagus. However, its use has been limited, primarily because of the side effects, which include esophageal strictures, cutaneous photosensitivity, chest pain, and nausea and vomiting. The tolerability aspects of photodynamic therapy, as well as the dosimetry, though, can be improved with existing technologies to further develop this therapy into truly a widely applicable therapy. Studies have recently been done to help identify patients more likely to suffer stricture after photodynamic therapy. In addition there has been evidence to suggest that the efficacy of photodynamic therapy also can be limited by genetic abnormalities in the mucosa. By combining knowledge of tissue biology, optical properties of the tissue, and dosimetry issues with ablation, photodynamic therapy can still have a potentially bright future.
Subject(s)
Adenocarcinoma/drug therapy , Barrett Esophagus/drug therapy , Esophageal Neoplasms/drug therapy , Photochemotherapy/instrumentation , Precancerous Conditions/drug therapy , Adenocarcinoma/mortality , Adenocarcinoma/pathology , Barrett Esophagus/mortality , Barrett Esophagus/pathology , Biopsy , Combined Modality Therapy , Dose-Response Relationship, Drug , Equipment Design , Esophageal Neoplasms/mortality , Esophageal Neoplasms/pathology , Esophagoscopes , Esophagus/drug effects , Esophagus/pathology , Follow-Up Studies , Hematoporphyrin Photoradiation/instrumentation , Humans , Neoplasm Recurrence, Local/drug therapy , Neoplasm Recurrence, Local/mortality , Neoplasm Recurrence, Local/pathology , Neoplasm Staging , Precancerous Conditions/mortality , Precancerous Conditions/pathology , Survival RateABSTRACT
The general public and the medical community often perceive dying patients' quality of life (QOL) as rapidly deteriorating before death. However, with appropriate palliative services, this effect may be positively modified. Objective data are lacking on the true experience of dying from the point of view of the patient that this pilot study begins to address. Patients caregivers, and staff in our hospice program completed questionnaires evaluating the patient's QOL every 2 weeks until the patient's death. This pilot study found that patients QOL was relatively high and stable over time. Primary caregivers rated the patient's QOL lower than patient self-ratings, whereas the hospice staff evaluated the patient's QOL similarly to the patient. Many dying patients suffer and are perceived as having no QOL in the final days by their caregivers. This perception may be modified to maintain one's QOL with the help of palliative medical services, thereby relieving the suffering of those who are actively facing death.
