Long term quality of life in conservatively treated gastric lymphoma patients versus gastrectomized patients and gastritis patients

Abstract

Background: Primary gastric lymphoma was defined as a distinct subgroup in the lymphoma standard classification (“REAL”). A change in the approach to gastric lymphoma treatment has been occurring during the last decade. In many medical centers, but not all, conservative treatment (chemotherapy with or without radiotherapy) is becoming the preferred treatment, rather than gastric surgery (partial or radical gastrectomy), due to similar survival. Given that survival is comparable, quality of life (QOL) may be of decisive impact on choice of treatment. This work aimed to compare long term QOL of these two treatments in gastric lymphoma. Gastroenterologists are positioned such that we must decide whether to refer patients whom we newly diagnose as having gastric lymphomas, either to surgeons or to oncologists. Methods: The study instruments were the EORTC-QLQ-30 and EORTC-STO- 22 questionnaires. The participants are patients of Rambam health care center, a tertiary oncology center. The QOL of conservatively treated gastric lymphoma patients (n=22) was compared with the QOL of patients who have underwent gastrectomy in treatment of gastric malignancy (n=34). The results were also compared to a group of patients with chronic gastritis (the control group, n=31). Results: The conservative treatment group had no disadvantages and some statistically significant advantages compared with gastrectomized group, notably having significantly less of the following: nausea and vomiting (p<0.04), sleep disturbances (p<0.018), constipation (p<0.017), diarrhea (p<0.0001), financial difficulties (p< 0.018), solid food dysphagia (p<0.0003), liquefied food dysphagia (p<0.032), discomfort during meals (p<0.046), reflux (0.023), heartburn (p<0.0024), belching (p<0.0039), early satiety (p<0.047), and anxiety regarding hair loss (p<0.004)]. The control group had no statistically significant advantages over the conservative treatment group. Conclusions: The long term QOL of conservatively treated gastric lymphoma patients is comparable to gastritis patients, and is better than the quality of life of patients undergoing gastrectomy due to malignancy symptom-wise. These findings support the growing tendency to choose conservative oncological treatments rather than surgery for gastric lymphoma patients as the first line of therapy.