Stephen J.LurieMD, PhD, Senior EditorIndividualAuthor
In Reply: We agree with Dr Urbach that one
of the factors that likely contributed to the finding of no difference between
treatment arms in the 2-day postoperative pain distress scores was that patients
assigned to the open colectomy arm reported only moderate levels of pain distress.
We speculated that effective postoperative analgesia blunted their pain distress.
While it is possible that the SDS (and the pain distress scale in particular)
was insensitive to postoperative symptoms, we are reassured by the consistency
of the results obtained with 3 different QOL scales at multiple time points.
In addition, the modest differences observed between groups in length of stay
and the duration of analgesic use suggest that our instruments did not miss
important differences in QOL between treatment groups. We agree that much
less is known about the psychometric properties of available QOL instruments
in surgical settings than in medical ones. However, we believe that the best
way to close this gap is to make QOL assessment a more common feature of surgical
trials in varied patient populations and clinical settings. If these studies
use several instruments concurrently and pay careful attention to the relationships
between QOL and clinical outcomes, they will generate exactly the kind of
psychometric data that are needed to help move the field forward.
Weeks J, Nelson H, Sargent D. Laparoscopic-Assisted Surgery for Colon Cancer—Reply. JAMA. 2002;287(15):1938-1939. doi:10.1001/jama.287.15.1935