Quality Of Life After Endobronchial Intervention Of Malignant Central Airway Obstruction

BACKGROUND: Patients with malignant central airway obstruction (mCAO) may need endobronchial intervention for symptoms relief (dyspnea, hemoptysis, post-obstructive pneumonia), but also to manage atelectasis and consequent respiratory failure that does not allow their treatment to continue. Quality of life (QoL) has been closely linked with symptom intensity in lung cancer patients. It is therefore important to relieve respiratory distress and inform patients, especially those who receive palliative care, about the benefits of an eventual endobronchial intervention. METHODS: Over an 18-month period, we enrolled 29 patients with symptomatic malignant central airway obstruction in order to re-establish airway patency. QoL and dyspnea were evaluated by the EORTC -C30 and EORTC -LC13 Questionnaire before the intervention, 1 week after and every following month until first relapse or death. RESULTS: Overall, 44.8% of patients (n=13) had poor Performance status (PS >= 3) and 51.7% (n=15) of patients were stage IV disease. QoL improved significantly from the first week up to the 6th month (p<0.05). Global Health Questionnaire improved from 29.6 (Standard deviation=19.2) to 70.8 (50=30.5) (p<0.05) on week 24. Dyspnea accessed with EORTC-LC13 questionnaire decreased from 73.2 (SD=29.2) to 23.6 (50=26) (p<0.05) on week 24. Patients with PS >= 3 and those at stage IV had greater improvement. Benefits were seen independent of histology of malignancy or history of post-obstructive pneumonia. Mean time until first relapse was 21.2 weeks (SD=20.5) (n=6 patients) and time until death was 15.1 weeks (SD=7.9) (n=16 patents). Patients treated with chemotherapy before the intervention and those with stenosis of trachea and left main bronchus had worse survival. CONCLUSIONS: Interventional management of patients with mCAO results in sustained significant improvement of QoL and shortness of breath and should be considered as essential component of multidisciplinary cancer care approach.