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April 17, 2002

Laparoscopic-Assisted Surgery for Colon Cancer—Reply

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthor

JAMA. 2002;287(15):1938-1939. doi:10.1001/jama.287.15.1935

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.

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