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. 2023 Jun;17(3):815-825.
doi: 10.1007/s11764-022-01257-1. Epub 2022 Oct 11.

Health-related quality of life 15 years after oesophageal cancer surgery: a prospective nationwide cohort study

Anna Schandl  1   2   3 , Zhao Cheng  4 , Asif Johar  4 , Pernilla Lagergren  4   5
Affiliations

Health-related quality of life 15 years after oesophageal cancer surgery: a prospective nationwide cohort study

Anna Schandl et al. J Cancer Surviv. 2023 Jun.

Abstract

Purpose: We aimed to study oesophageal cancer survivors' health-related quality of life (HRQL) 15 years after surgery and to identify factors related to reduced HRQL.

Methods: A nationwide, prospective cohort study enrolling 616 patients who underwent open oesophageal cancer surgery in Sweden between April 2, 2001, and December 21, 2005. HRQL was evaluated by questionnaires 15 years after surgery. HRQL data for the 15-year survivors were individually matched for age, sex and comorbidity by using values from a Swedish background population. Multivariable linear regression models provided mean score differences (MSD) with 95% confidence intervals (CI) for each HRQL scale and item.

Results: Among the 616 individuals in the original study group, 70 (11%) survived for 15 years and 52 (74%) responded to the questionnaires. Compared with a matched background population, the survivors reported problems in 10 of 25 HRQL aspects. Most of these were related to symptoms of the digestive tract, such as reflux (MSD 26.4, 95%CI: 18.3 to 34.4), dysphagia (MSD 17.7, 95%CI: 10.0 to 25.4) and eating difficulties (MSD 16.4, 95%CI: 11.3 to 21.4). Major postoperative complications after surgery were related to worse HRQL in 11 of 25 aspects.

Conclusions: This study suggests that surgery for oesophageal cancer entails long-term, possibly life-long, symptoms related to the digestive tract.

Implication for cancer survivors: Comprehensive support from healthcare may be imperative for oesophageal cancer survivors to adapt to and cope with consequences of oesophageal cancer surgery. Prevention, early identification and adequate treatment of postoperative complications may improve patient outcome.

Keywords: EORTC QLQ-C30; EORTC QLQ-OES18; Functions; Long-term follow-up; Survivorship; Symptoms.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Adjusted results for global quality of life, functional scales and symptom scales and items 15 years after oesophageal cancer surgery categorised by postoperative complications, without postoperative complications and for the reference population (RP) presented as mean scores with 95% confidence intervals (CI). In global quality of life and functional scales, high scores indicate better HRQL. High scores in symptom scales and items correspond to more symptoms. QL = global quality of life; PF = physical function; RF = role function; EF = emotional function; CF = cognitive function; SF = social function; FA = fatigue; NV = nausea/vomiting; PA = pain; DY = dyspnoea; IN = insomnia; AP = appetite loss; CON = constipation; DI = diarrhoea; FI = financial difficulties
Fig. 2
Fig. 2
Adjusted results for oesophageal specific symptom scales and items in 15-year survivors after surgery categorised by postoperative complications, without postoperative complications and for the reference population (RP) presented as mean scores with 95% confidence intervals (CI). The higher scores, the more symptoms. DYS = dysphagia; RF = reflux; EA = eating difficulties; EPA = oesophageal pain; SA = trouble swallowing saliva; CH = choking; DM = dry mouth; CO = coughing; SP = speech problems; TA = taste problems
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