Affiliation:
1. Surgical Care Science, Department of Molecular Medicine and Surgery Karolinska Institutet, Karolinska University Hospital Stockholm Sweden
2. Upper Gastrointestinal Surgery, Department of Molecular medicine and Surgery Karolinska Institutet, Karolinska University Hospital Stockholm Sweden
3. School of Cancer and Pharmaceutical Sciences King's College London UK
4. Department of Surgery and Cancer Imperial College London London UK
Abstract
AbstractBackgroundThe presence of distinct long‐term disease‐specific HRQL trajectories after curative treatment for esophageal cancer and factors associated with such trajectories are unclear.Materials and MethodsThis population‐based and longitudinal cohort study included 425 esophageal cancer patients who underwent curative treatment, including esophagectomy, in Sweden in 2001–2005 and were followed up until 2020, that is, 15‐year follow‐up. The outcomes were 10 disease‐specific HRQL symptoms, measured by the well‐validated EORTC QLQ‐OES18 questionnaire at 6 months (n = 402 patients), and 3 (n = 178), 5 (n = 141), 10 (n = 92), and 15 years (n = 52) after treatment. HRQL symptoms were examined for distinct trajectories by growth mixture models. Weighted logistic regression models provided odds ratios (OR) with 95% confidence intervals (95% CI) for nine factors in relation to HRQL trajectories: age, sex, education, proxy baseline HRQL, comorbidity, tumor histology, chemo(radio)therapy, pathological tumor stage, and postoperative complications.ResultsDistinct HRQL trajectories were identified for each of the 10 disease‐specific symptoms. HRQL trajectories with more symptoms tended to persist or alleviate over time, while trajectories with fewer symptoms were more stable. Eating difficulty had three trajectories: persistently less, persistently moderate, and persistently more symptoms. The OR of having a persistently more eating difficulty trajectory was decreased for adenocarcinoma histology (OR = 0.44, 95% CI 0.21–0.95), and increased for pathological tumor stage III‐IV (OR = 2.19, 95% CI 0.99–4.82) and 30‐day postoperative complications (OR = 2.54, 95% CI 1.26–5.12).ConclusionDistinct trajectories with long‐term persistent or deteriorating disease‐specific HRQL symptoms were identified after esophageal cancer treatment. Tumor histology, tumor stage, and postoperative complications may facilitate detection of high‐risk patients for unwanted trajectories.