Palliative care of people with oesophageal cancer

Palliative management of patients with incurable oesophageal cancer necessitates a broad spectrum of measures to relieve symptoms. Symptoms include those generated by the direct effects of disease (dysphagia due to local tumour burden) and the systemic effects of advanced cancer. Aggressive surgical treatments are rarely indicated for locally advanced disease because of the high associated morbidity and mortality. Interventions are aimed at eliminating dysphagia with options including stenting and tumour-specific treatments. Likewise, systemic disease responds in a limited way to aggressive therapy. The aim of all therapy (disease-modifying or direct symptom measures) is to optimise levels of function and comfort in the face of advancing disease. The choice of interventions depends upon the symptoms experienced, the overall functional status of the person, the estimated prognosis of the person, the sites of disease spread and the patient’s preference. Palliative management requires a multidisciplinary approach including the active engagement of the patient’s general practitioner.