Abstract
Health–related quality of life (HRQL) is a multi-dimensional concept that includes physical, emotional, mental, and social functioning. HRQL focuses on the impact of a disease state, or its treatment, on an individual’s subjective reporting of their ability to live a meaningful and quality lifestyle under the constraints of the disease or its treatment. Historically, the exceedingly high mortality and morbidity associated with esophagectomy prohibited any meaningful consideration of post-operative HRQL. Current treatment modalities have improved both perioperative outcomes and long-term survival. However, there is still a significant negative impact of treatment on HRQL. The most commonly encountered long-term issues related to HRQL after esophagectomy include diminished physical function, gastrointestinal disturbances, alterations in body composition, and impaired psychosocial reintegration.
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Appendix: Summary of Prospective Studies Assessing HRQL in Esophageal Cancer
Appendix: Summary of Prospective Studies Assessing HRQL in Esophageal Cancer
Authors, year | n | Median length of follow-up (months) | Study design | Results |
---|---|---|---|---|
Scarpa [26] 2012 | 1282 | 12 | Meta-analysis | – Global QOL markedly decreased following surgery (p = 0.04) – Global QOL increased through the first 6 postoperative months, but role and physical function never increased to baseline – On multivariate analysis, emotional function and dysphagia at diagnosis were directly associated to global QOL at diagnosis (p = 0.001 and p < 0.0001, respectively) – Patients experiencing any kind of postoperative complication had the same global QOL as those who did not, but had worse emotional function long term and worse physical function short term |
Kauppila [22] 2017 | 2064 | 12 | Meta-analysis | – Patients reported better global QOL, physical function, fatigue, and pain at 3 months following minimally-invasive versus open esophagectomy – This differences failed to be significant at 6 and 12 months follow-up |
Van Heijl [51] 2009 | 199 | 3 | Prospective RCT | – In the postoperative multivariate analysis, social functioning (p = 0.035), pain (p = 0.026), and activity level (p = 0.037) predicted survival, besides pathological T-stage (p < 0.001) and N-stage (p < 0.001) |
De Boer [52] 2004 | 199 | 36 | Prospective RCT | – Three months after the operation, patients in the transhiatal esophagectomy group (n = 96) reported fewer physical symptoms (P = 0.01) and better activity levels (P < 0.01) than patients in the transthoracic group (n = 103), but no differences were found at any other measurement point |
Maas [24] 2015 | 115 | 12 | Prospective RCT | – Overall HRQL was improved at 1 year for both minimally-invasive and open esophagectomy compared to preoperative and 6-week postoperative scores – Patients who underwent minimally-invasive esophagectomy had significantly improved physical activity (p = 0.003), global health (p = 0.004) and pain (p = 0.001) scores at 1-year follow-up compared to those who underwent open esophagectomy |
Noordman [53] 2017 | 363 | 12 | Prospective RCT | – HRQL declined during neoadjuvant chemoradiotherapy, but this effect was not apparent in postoperative HRQL compared to surgery-alone |
Djarv [16] 2010 | 169 | 60 | Prospective population based cohort | – Pre-treatment dyspnea was associated with shorter post-treatment survival – Better recovery of physical function, pain, and fatigue at 6 months post-treatment was associated with longer survival |
Viklund [25] 2005 | 100 | 6 | Prospective population based cohort | – Surgically related complications were main predictors of decreased QOL at 6 months (score of 54 from reference of 65) (p = 0.03) |
Djarv [14] 2009 | 355 | 6 | Prospective population based cohort | – Pre-treatment comorbidities, tumor stage III to IV, and tumor location in the middle and upper 1/3 of the esophagus were associated with poorer post-treatment HRQL – Patients with adenocarcinoma had better 6-month post-treatment HRQL than those with squamous cell carcinoma |
Derogar [54] 2012 | 141 | 60 | Prospective population based cohort | – Dyspnea (MD, 15; 95% CI, 6–23), fatigue (MD, 13; 95% CI, 5–20), and eating restrictions (MD, 10; 95% CI, 2–17) were clinically and statistically significantly deteriorated throughout the follow-up in patients with major postoperative complications compared with patients without major complications |
Blazeby [20] 2005 | 103 | 22 (Chemoradiotherapy and surgery) 11 (Chemotherapy and surgery) 27 (Esophagectomy alone) | Prospective cohort | – Neoadjuvant therapy has a temporary negative effect on HRQL, most commonly related to treatment toxicity – Neoadjuvant therapy does not impair recovery of HRQL postoperatively |
Zieren [55] 1996 | 149 | 12 | Prospective cohort | – The most significant factors in reducing postoperative QOL was recurrence (p < 0.01) and anastomotic stricture (p < 0.05) – QOL decreased initially postoperatively, but was restored at 6 months in disease-free patients |
McKernan [17] 2008 | 152 | 81 | Prospective cohort | – On multivariate analysis, tumor stage (p < 0.001), operative treatment (p < 0.0001) and appetite loss (p < 0.0001) were independent predictors of cancer-specific survival |
Parameswaran [23] 2010 | 62 | 12 | Prospective cohort | – Patients had lower HRQL in the first 6 weeks following minimally invasive esophagectomy – HRQL scores returned to baseline at 6 months postoperatively and were maintained at 24 months |
Healy [18] 2008 | 185 | 20 | Prospective cohort | – Global QOL was associated with in-hospital mortality (p = 0.02) but not with major morbidity, cancer recurrence, or 1-year survival – On multivariate analysis, pre-treatment dyspnea predicted in-hospital mortality (p = 0.042) and pre-treatment fatigue was associated with reduce 1-year survival (p = 0.033) |
Reynolds [21] 2006 | 202 | 12 | Prospective cohort | – Neoadjuvant treatment reduced physical (p = 0.004) and role (p = 0.007) function prior to surgery while improving dyspnea (p = 0.043) – Esophagectomy negatively impacted HRQL scores at 3 months in both multimodal and surgery-alone groups, with improvement in scores at 6 months – At 12 months, global QOL was better in the multimodal group than in the surgery-alone group (P = 0.044) |
Donohoe [56] 2011 | 132 | 70 | Prospective cohort | – Global health status was significantly reduced at least 1 year after esophagectomy (mean ± SD score 48.4 ± 18.6) when compared to pre-treatment. The degree of subjective swallowing dysfunction was highly correlated with a poor QOL (Spearman’s ρ = 0.508, p < 0.01). |
Egberts [57] 2008 | 105 | 24 | Prospective cohort | – There was no statistically significant difference in any of the HRQL scales between patients with a cervical or a thoracic anastomosis. |
Fujita [58] 1995 | 128 | NR | Prospective cohort | – Three field lymphadenectomy resulted in similar HRQL to two field surgery |
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DeSouza, M., Donohoe, C.L., Dolan, J.P. (2018). Quality of Life After Esophagectomy. In: Schlottmann, F., Molena, D., Patti, M. (eds) Esophageal Cancer. Springer, Cham. https://doi.org/10.1007/978-3-319-91830-3_19
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