Palliation by laser photoablation: a multidisciplinary quality assessment

To evaluate the quality of life and degree of palliation by laser photoablation for gastrointestinal cancer, a questionnaire was sent to general practitioners (GPs) and referring specialists. The response was 85%. General practitioners considered palliation by laser to be effective in 74% compared with 50% for referring specialists (p less than 0.001). Specialists felt themselves unable to answer in 17% compared with no GPs (p less than 0.001). The differences in assessment between specialists and GPs were most pronounced in colorectal cancers. There was a striking consensus of opinion about the rate of failed palliation among endoscopist, referring specialist, and GP. On the other hand, the rating of success by specialists and GPs was significantly lower than the endoscopist's evaluation. The endoscopist and GP were more at variance than the endoscopist and specialist. Above all, the GPs seemed to outweigh the burden against the benefits of treatment. Disagreement of the specialists and the GPs with the endoscopist about the outcome appeared to be related to unrealistic expectations, to a shift in presenting symptoms or to complications, misinterpreted as being laser-induced but mainly due to progression of disease.