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Background: The main outcome parameters in esophageal oncology have traditionally been morbidity and mortality but recent improvements in the treatment of esophageal cancer suggest to take in consideration quality of life. Esophagectomy is associated with significant deterioration of the health related quality of life, which persists during the follow-up period. The aim of this study was to analyze quality of life before and after esophagectomy for esophageal cancer and to identify possible predictors of quality of life at the different steps of the treatment.
Patients and methods One hundred twenty six consecutive patients presenting with esophageal cancer at the Oncological Surgery Unit of the Veneto Institute of Oncology have been enrolled in this prospective study from 2009 to 2011. The patients answered to three quality of life questionnaires at diagnosis of esophageal cancer, after the neoadjuvant therapy, after surgery and at 1, 3, 6 and 12 months after surgery. The questionnaires were administered during the hospitalization and outpatient visits. The questionnaires were the Italian version of the QLQ-C30, QLQ-OES18 and IN-PATSAT32 models, developed by the European Organization for Research and Treatment of Cancer (EORTC). Univariate and multivariate analysis were performed.
Results: Global quality of life (QL2 item) improved after neoadjuvant therapy compared to the baseline levels, it decreased immediately after surgery (p=0.06) and then it improved after 1 year (p=0.03). At diagnosis, QL2 item correlated significantly with tumor size, gender and dysphagia but none of these items was an independent predictor at multivariate analysis. After neoadjuvant therapy, only age revealed to be an independent predictor of good quality of life (b=0.33, p=0.02). After surgery, gastroenterological complications of radiochemotherapy were independent predictor of poor quality of life (b=-0.33, p=0.04). One year after esophagectomy postoperative complications were independent predictor of poor quality of life at this stage (b=-0.63, p=0.01). Dysphagia (DYS item) improved dramatically after surgery (p<0.01). After surgery DYS was independently predicted by the presence of skin complication of chemo radiation, hospital stay duration and the use of jejunostomy (b=0.33, p=0.04, b= 0.40, p=0.04 and b=-0.45, p=0.02, respectively).
Conclusions: Even if in the short-term quality of life seems to be negatively influenced by esophagectomy after 12 months the scale returns to baseline levels. However, the minimally invasive techniques do not seem to confer special benefits. On the contrary, dysphagia improve significantly after esophagectomy. Older patients seem to cope more easily with neoadjuvant therapy while complications of chemo radiation and of surgery deeply affect quality of life at different stage of the natural history of the disease.