Quality of life and persisting symptoms after oesophageal cancer surgery

https://doi.org/10.1016/j.ejca.2006.02.005Get rights and content

Abstract

To assess quality of life (QoL) and symptoms after oesophageal cancer surgery, a prospective nationwide population-based study was conducted in 2001–2005, including most surgically treated oesophageal cancer patients in Sweden. Six months postoperatively patients responded to an EORTC quality of life core questionnaire (QLQ C-30) with an oesophageal-specific module (OES-18). Mean scores were calculated. Mann-Whitney test was used for group comparisons. Among 282 patients, QoL was considerably reduced compared to a reference general population (P < 0.001), and functioning scales were similarly negatively affected; particularly role (P < 0.001) and social (P < 0.001) functions. Younger patients scored worse than older. No gender differences were found. Dominating general symptoms included fatigue, appetite loss, diarrhoea, and dyspnoea, each significantly more pronounced than the general population (P < 0.001). Eating problems, cough, reflux, and oesophageal pain were common oesophageal-specific symptoms. Thus, patients who undergo oesophageal cancer resection suffer greatly from reduced QoL and several general and oesophageal-specific symptoms six months postoperatively.

Introduction

Oesophageal resection alone is the most established treatment that can offer a cure for patients with oesophageal cancer.1 The outcome measure used in most research on oesophageal cancer surgery has been survival, on account of its obvious relevance and its ease of interpretation and calculation.2 A second relevant outcome measure is the occurrence of postoperative complications, which has been less well studied even though oesophageal cancer surgery is burdened with a substantial risk of severe complications.3, 4, 5, 6 Complications have recently been shown to impair the patients’ long-term quality of life (QoL) postoperatively.7 QoL is, in turn, a third relevant outcome measure, and this is addressed in the current study. QoL after oesophageal cancer surgery has only been reported in studies of small or selected samples, and no population-based investigations are available.8, 9, 10 Recent advances in the development of self-administered structured and validated tools for the assessment of QoL and general symptoms, designed for cancer patients, as well as of organ-specific symptoms, including an oesophageal-specific module, have developed QoL research.11, 12 Assessment of the QoL would seem particularly important after oesophageal cancer surgery.13 Even though this surgery is especially extensive, the majority of the surgically treated patients die from spread of their oesophageal cancer within three years.1, 14 Thus, most oesophageal cancer resections can only offer palliation. The high prevalence of morbidity, which can reduce the QoL, is recognized among oesophageal surgeons. To our knowledge however, there have been no population-based studies in which systematic attempts have been made to estimate the QoL or morbidity among surgically treated oesophageal cancer patients. We therefore conducted a nationwide, prospective, population-based study in Sweden with the principle aim of obtaining valid measures of the QoL and information on general and oesophageal-specific symptoms six months after oesophageal cancer surgery, and to compare the results with the general population.

Section snippets

Study design

A prospective, population-based study was performed in Sweden during the four-year period April 2, 2001 through June 30, 2005. Eligible for the study were all Swedish residents newly diagnosed with an oesophageal or cardia cancer who were treated by oesophageal resection during the period April 2, 2001 through December 31, 2004. The data were collected from the Swedish Esophageal and Cardia Cancer (SECC) register, an almost complete nationwide surgical register. The principles of the

Patients

During the four-year study period, 458 patients treated with surgery with a curative intent for oesophageal or gastric cardia cancer were recorded in the SECC register. Of these, 96 (21%) died before the six-month follow-up, 31 (7%) did not respond to the questionnaire, and 49 (11%) did not receive the questionnaire in time for the follow-up because of delayed registration. Thus, 282 (62%) patients who had undergone oesophageal resection remained for final analysis. Some characteristics of the

Discussion

This population-based study indicates that the QoL is greatly reduced and that various general and oesophageal-specific symptoms still constitute major problems six months after oesophageal cancer surgery. Compared to a reference population and to other cancer patients, the global QoL, functional scales, and general symptoms, particularly fatigue, appetite loss, and diarrhoea, were considerably worsened among the study patients. Eating problems were the single worst persisting

Conflict of interest statement

There are no conflicts of interest.

Acknowledgement

Funding was provided by the Swedish Cancer Society and the National Board of Health and Welfare in Sweden. We are grateful to Eja Fridsta for invaluable help with the fieldwork of the Swedish Esophageal and Cardia Cancer register (SECC). We sincerely appreciate the collaboration with all contact doctors participating in the SECC register, namely Erik Aasberg, Gunnar Adell, Stig-Olof Almgren, Christer Andersson, Bengt Anesten, Ebbe Ankeraa, Lena Appelgren, John Blomberg, Bernt Boeryd, Poul

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