Quality of life assessment in esophagectomy patients

Abstract

Esophagectomy is the mainstay of curative therapy for esophageal cancer; however, it is associated with significant morbidity and mortality, with subsequent major impact on quality of life. This paper reviews the evaluation of health-related quality of life (HRQOL) in esophageal cancer patients undergoing curative intent therapy, the relationship between postoperative HRQOL and survival as well the potential utility of pre-treatment HRQOL as a prognostic tool. HRQOL assessment is valuable in helping clinicians understand the impact on patients of esophageal cancer and the various treatments thereof. HRQOL is also valuable as an end-point in studies of esophageal cancer and esophageal cancer treatment. Given the morbidity and mortality associated with the various treatments for esophageal cancer, it could be argued that HRQOL is as important an endpoint as survival, if not more so. Patient-reported pre-treatment HRQOL assessment appears to predict survival better than clinician-derived performance status assessment period. HRQOL assessment also appears to be responsive to surgical and non-surgical therapy and thus could potentially be used in trials and in practice to serve that function. Thus, HRQOL assessment could be a potentially important adjunct in shared decision-making and guiding treatment planning as well as monitoring the progress of treatment.

Keywords: Esophageal cancer; esophagectomy; health-related quality of life (HRQOL); patient-reported outcome.

Figure 1

Overall survival increases as FACT-E & ECS quartiles increase in patients with stage 2 and 3 esophageal cancer. (A) shows that FACT-E is significantly associated with overall survival while (B) describes a similar ECS association with overall survival (16). FACT-E, Functional Assessment of Cancer Therapy- Esophagus; ECS, esophageal cancer subscale.

Figure 2

Physical well-being scores: pretreatment, 7 weeks post neoadjuvant therapy, pre-surgery, 1, 3, 6 months after surgery, and 1 year after surgery (9). wks, weeks; M, month; yr, year; Sx, surgery.

Figure 3

Functional well-being scores: pretreatment, 7 weeks after neoadjuvant therapy, pre-surgery, 1, 3, and 6 months after surgery, and 1 year after surgery (9). wks, weeks; M, month; yr, year; Sx, surgery.