Longitudinal assessment of quality of life indicators and prognosis in esophageal cancer patients with curative resection

Abstract

Background: The relationship between quality of life and survival outcomes in esophageal cancer patients following curative resection is not well established. This study aimed to longitudinally assess quality of life indicators and their association with overall survival (OS) in these patients.

Methods: A total of 232 patients were included in the study, and their quality of life was prospectively assessed at different time points using the European Organisation for Research and Treatment of Cancer (EORTC) 30-item core quality of life questionnaire (QLQ-C30) and the disease-specific esophageal module (QLQ-OES18). The scores of QLQ indicators at each time point were summarized, and changes in postoperative assessment were compared with preoperative assessments. The association of deterioration in certain indicators with OS was evaluated at each time point using Cox univariable analysis. Further confirmation of independent variables was carried out using Cox multivariable analysis.

Results: The study cohort comprised 62 females (26.7%), and 113 patients (48.7%) aged over 60 years. The median follow-up time was 80 months (range, 8-118 months). At 24 months after discharge, patients reported improvements in role function, fatigue, cognition function, emotional function, social function, insomnia, appetite loss, nausea and vomiting, constipation, financial status, trouble swallowing saliva, and pain related to esophageal cancer. However, physical function, dyspnea, diarrhea, global health status, choking when swallowing, trouble talking, and reflux remained compromised. Multivariable regression analysis revealed deterioration in role function, emotional function, and coughing difficulty at 6 months, and dyspnea, pain, and cognitive function at 24 months post-discharge were identified as independent prognostic factors for OS.

Conclusions: Our findings underscore the importance of monitoring quality of life indicators in esophageal cancer patients as they may significantly influence survival outcomes. The identification of specific quality of life indicators as prognostic factors highlights the need for a patient-centered approach in clinical practice to enhance care and potentially improve survival.

Keywords: Survival analysis; esophageal cancer; patient-reported outcome; quality of life.

Figure 1

A flowchart of patient inclusion and exclusion.

Figure 2

The distributions of QLQ-C30 quality of life indicators and comparisons at different time points. A, baseline; B, at discharge; C, 3 months after discharge; M, 6 months after discharge; E, 12 months after discharge; F, 24 months after discharge. The value between two time points indicates the P value using the Wilcox test or the Kruskal-Wallis test. PF, physical functioning; RF, role functioning; EF, emotional functioning; CF, cognitive functioning; SF, social functioning; QL, global health status; FA, fatigue; NV, nausea and vomiting; PA, pain; DY, dyspnoea; SL, insomnia; AP, appetite loss; CO, constipation; DI, diarrhea; FI, financial difficulties.

Figure 3

The distributions of QLQ-OES18 quality of life indicators and comparisons at different time points. A, baseline; B, at discharge; C, 3 months after discharge; M, 6 months after discharge; E, 12 months after discharge; F, 24 months after discharge. The value between two time points indicates the P value using the Wilcox test or the Kruskal-Wallis test. OESDYS, dysphagia; OESEAT, problems with eating; OESRFX, reflux; OESPAIN, pain related to esophageal cancer; OESSV, trouble swallowing saliva; OESCH, choked when swallowing; OESDM, dry mouth; OESTA, trouble with taste; OESCO, trouble with coughing; OESSP, trouble talking.

Figure 4

The survival of two groups of the worse and similar or better status of independent prognostic factors. Subgraphs (A-H) represent the survival of two groups of the worse and similar or better status of role function, emotional function, and trouble with coughing in 6 months after discharge, fatigue and emotional function in 12 months after discharge, and dyspnoea, pain, and cognitive function in 24 months, respectively. RF, role functioning; EF, emotional functioning; OESCO, trouble with coughing; FA, fatigue; DY, dyspnoea; PA, pain; CF, cognitive functioning.