Health-Related Quality of Life in Patients with Oesophageal Cancer: Analysis at Different Steps of the Treatment Pathway

Background: The main outcome parameters in oesophageal surgery have traditionally been morbidity and mortality, but quality of life (QL) has become an important consideration in view of the severity and persistence of postoperative symptoms. The aim of this study was to analyse QL before and after oesophagectomy for oesophageal cancer and to explore possible association with patient's and disease characteristics. Patients and Methods: One hundred twenty-six consecutive patients presenting with oesophageal cancer to the Oncological Surgery Unit of the Veneto Institute of Oncology between 2009 and 2011 were enrolled in this prospective study. The patients were asked to answer three QL questionnaires (the Italian versions of the QLQ-C30, the QLQ-OES18, and the IN-PATSAT32 modules developed by the European Organization for Research and Treatment of Cancer) at the time of disease diagnosis, after neoadjuvant therapy, immediately after surgery and at 1, 3, 6 and 12 months postoperatively. Results: Global quality of life (QL2 item) seemed to improve after neoadjuvant therapy but it dropped markedly after surgery. It then rose to a value in between the one registered after neoadjuvant therapy and the one at diagnosis. Emotional function and dysphagia were associated to QL2 at diagnosis. After neoadjuvant therapy, age, oesophageal stenosis, emotional function and dysphagia were associated to good quality of life at that stage. After surgery, pain was associated to quality of life at that stage. During the early follow-up phase (1-3 months after surgery), role function and postoperative urinary complications were associated to QL2. In the long-term follow-up (6-12 months), adjuvant therapy, eating disorders and postoperative complications were associated to poor quality of life. Conclusions: Postoperative complications are associated to long-term emotional and physical function impairment which can lead to a significantly impaired global quality of life. Postoperative pain relief plays a key role in achieving a good postoperative quality of life. Finally, HRQL after oesophagectomy seems to be a function of therapeutic efficacy rather than of the specific surgical procedure used.