This was an interesting study that assessed quality of life in a very important group of patients (those with disseminated adenocarcinoma). However, it has some drawbacks. Sample size was probably too small for statistically significant effects to be detected (i.e. the study had low power). Also, the study methodology did not exclude bias: patients were assigned to intervention/comparator based on chronological criteria, not randomly. As for measuring effectiveness, quality of life was assessed by oncologists, not by the patients themselves (which could have changed the quality of life measure). More information would have been desirable on the costing methodology, although it seems to have been reasonable. A sensitivity analysis was needed in order to evaluate uncertainty in estimated parameters.
Assessing quality of life is a very complex issue, and thus the measures given here need to be cautiously assessed (particularly since the questionnaires were not answered by the patients themselves). Finally, a case series study is subject to bias that only a properly conducted randomised controlled trial can eliminate.