4738 Evaluation of quality of life in the palliative treatment with percutaneous endoscopic gastrostomy of intestinal occlusion caused by gynecological tumors.

Obstruction of upper gastrointestinal tract is a frequent consequence of gynecological tumors metastatic in the peritoneal cavity. Such condition requires chronic gastric decompression that is possible to obtain by PEG. The effectiveness of PEG in reducing severe symptoms as nausea, vomiting and abdominal relaxation has been assessed in previuos study (Endoscopy `95).AIM of the study is to evaluate the global QoL of PEG pts. METHODS: Since 1998 until today, 25 consecutive pts (median age 58 years;range 32-79), have been interwieved prior and seven day after the placing of PEG, in order to assess their QoL. All pts showed an intestinal occlusion. The QoL was evaluated by Symptom Distress Scale (SDS) of Mc Corkle and Young. The SDS assesses both psychological symptoms, as they are experienced by the patient, and their variation due to the course of the disease or the association with specific medical or psychological interventions. Lower scores are associated with a better QoL. Some symptoms such as fatigue, insomnia and appetite have been classified as somatopsychic since they are easily affected by the organic and the psychological components. RESULTS: As to the global QoL, of the 25 pts, 16 (64 %) have recovered (41 vs 32.6,pre and post PEG median scores respectively, p=0.003), 2 (8%)have shown the same scores as at baseline, and 7 (28 %) have worsened (30.85 vs 36.14,p= 0.18). Of the 16 pts showing an improvement in the QoL, 9/16 reported a reduction in symptoms at a physical (19.16 vs 14.75 , p=0.004), psychological (10.1 vs 7.3, p=0.03), and somatopsychic level (11.25 vs 9.2, p=0.03). Of the remaining 7/16 pts, 1 reported a physical impairment, 3 a psychological worsening and 3 a somatopsychic impairment.The worsening of global QoL found in 7/25 pts was determined particularly by the persistence of the physical symptoms - pain, nausea, intestinal activity, breathing and cough - (14.57 vs 20, p=0.02). CONCLUSIONS: Our results suggest that PEG in pts with obstruction of the upper gastrointestinal tract improves their global QoL. It effectively affects the physical and, less specifically the psychological symptoms. However, as these two aspects are so closely linked together in this phase of the disease, we can report an improvement also at the psychological level. It is important to give a specific treatment in order to provide a global assistance to the terminally ill patient.