Systematic review of health-related quality of life after esophagectomy for esophageal cancer

Abstract

This study is aimed to assess the long-term health-related quality of life (HRQL) of patients after esophagectomy for esophageal cancer in comparison with established norms, and to evaluate changes in HRQL during the different stages of follow-up after esophageal resection. A systematic review was performed by searching medical databases (Medline, Embase and the Cochrane Library) for potentially relevant studies that appeared between January 1975 and March 2011. Studies were included if they addressed the question of HRQL after esophageal resection for esophageal cancer. Two researchers independently performed the study selection, data extraction and analysis processes. Twenty-one observational studies were included with a total of 1282 (12-355) patients. Five studies were performed with short form-36 (SF-36) and 16 with European Organization for Research and Treatment of Cancer (EORTC) QLQ C30 (14 of them also utilized the disease-specific OES18 or its previous version OES24). The analysis of long-term generic HRQL with SF-36 showed pooled scores for physical, role and social function after esophagectomy similar to United States norms, but lower pooled scores for physical function, vitality and general health perception. The analysis of HRQL conducted using the Global EORTC C30 global scale during a 6-mo follow-up showed that global scale and physical function were better at the baseline. The symptom scales indicated worsened fatigue, dyspnea and diarrhea 6 mo after esophagectomy. In contrast, however, emotional function had significantly improved after 6 mo. In conclusion, short- and long-term HRQL is deeply affected after esophagectomy for cancer. The impairment of physical function may be a long-term consequence of esophagectomy involving either the respiratory system or the alimentary tract. The short- and long-term improvement in the emotional function of patients who have undergone successful operations may be attributed to the impression that they have survived a near-death experience.

Surveillance versus esophagectomy in esophageal cancer patients with a clinical complete response after induction chemoradiation

“…The most significant areas where surgical patients suffer are predictably related to loss of their stomach's normal function: eating problems, reflux symptoms, loss of appetite, and diarrhea. However, these patients also had worse scores with general health measures like fatigue and dyspnea, and experienced lower overall physical function, vitality scores, and health perception than controls long-term (43). Notably, organ preservation in esophageal cancer patients has been shown to be predictive of global measures of HRQOL (44).…”

Quality of life assessment in esophagectomy patients

“…The incidence of esophageal cancer has been increasing steadily in the past few decades; along with thyroid cancer, it has become the fastest rising solid tumor in the Western hemisphere (1,2).…”

“…Patients have problems with appetite loss, dysphagia, regurgitation, early satiety and consequently, weight loss along with other issues like diarrhea and fatigue (2,14,15). Thus, the assessment of the effect of treatment on health-related quality of life (HRQOL) before, during and after treatment time is important for patients, caregivers and clinicians (15).…”

Evolution in Surgical Management of Esophageal Cancer

“…The results demonstrated that technical surgical complications had significant deleterious effects on quality of life; however, there was no significant overall deterioration in quality of life associated with the more extensive operative approaches in the absence of major postoperative complications. Multiple additional reports have highlighted that the single most important issue associated with poor quality of life is the occurrence of perioperative complications [50,51,52]. …”