The Journal of Thoracic and Cardiovascular Surgery
Volume 137, Issue 1 , Pages 36-42, January 2009

Health-related quality of life in esophageal cancer: Effect of neoadjuvant chemoradiotherapy followed by surgical intervention

  • Najib Safieddine, MD

      Affiliations

    • Division of Thoracic Surgery, Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
    • ,
  • Wei Xu, PhD

      Affiliations

    • Department of Biostatistics, Public Health Sciences, University of Toronto, Toronto, Ontario, Canada
    • ,
  • Sayed Mohammed Quadri, MD, FRCSC

      Affiliations

    • Division of Thoracic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
    • ,
  • Jennifer J. Knox, MD, FRCP

      Affiliations

    • Department of Medicine, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada
    • ,
  • Jennifer Hornby, BSc, CCRP

      Affiliations

    • Division of Thoracic Surgery, Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
    • ,
  • Joanne Sulman, MSW

      Affiliations

    • Department of Social Work, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
    • ,
  • Rebecca Wong, MD, FRCP

      Affiliations

    • Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada
    • ,
  • Maha Guindi, MD, FRCP

      Affiliations

    • Department of Pathology, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
    • ,
  • Shaf Keshavjee, MD, MSc, FRCSC, FACS

      Affiliations

    • Division of Thoracic Surgery, Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
    • ,
  • Gail Darling, MD, FRCSC, FACS

      Affiliations

    • Division of Thoracic Surgery, Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
    • Corresponding Author InformationAddress for reprints: Gail Darling, MD, FRCSC, FACS, Toronto General Hospital, Division of Thoracic Surgery, 9N-955, 200 Elizabeth St, Toronto, Ontario M5G 2C4, Canada.

Received 29 March 2007; received in revised form 24 September 2008; accepted 30 September 2008.

Objective

We sought to determine the effect of neoadjuvant chemoradiotherapy followed by surgical intervention on health-related quality of life in patients with esophageal cancer.

Methods

Health-related quality of life was evaluated in a prospective phase II study of neoadjuvant chemoradiotherapy followed by esophagectomy in 52 patients with carcinoma of the esophagus. Esophagectomy was performed 6 weeks after completion of induction. Functional Assessment of Cancer Therapy–Esophageal scoring was performed before treatment, 7 weeks after initiation of neoadjuvant therapy, before resection, and at 1, 3, and 6 months and 1 year after resection.

Results

Forty-three patients completed the entire treatment protocol. Functional Assessment of Cancer Therapy–Esophageal scores decreased significantly after chemoradiation at week 7 (120 vs 127 at baseline, P = .04) but returned to baseline levels before surgical intervention (127). Similarly, scores decreased significantly after surgical intervention (115 at 1 month, P = .02) but returned to baseline levels by 3 months postoperatively (127). At 1 year postoperatively, there was a statistically significant improvement in scores compared with those at baseline (139, P = .003). Functional Assessment of Cancer Therapy–Esophageal scores continued to increase over time for patients who were alive at least 1 year after the operation with or without disease but were observed to significantly decrease in those who died within 1 year after the operation (P = .0001). An increase in quality of life was associated with a significantly lower risk of death (P = .04).

Conclusion

Neoadjuvant therapy has a significant effect on health-related quality of life, but this is transient, with recovery to baseline within 5 to 7 weeks after completion of induction therapy. Health-related quality of life decreases again after surgical intervention but returns to baseline levels within 3 months.

Abbreviations and Acronyms: EORTC, European Organization for Research and Treatment and Cancer, FACT-E, Functional Assessment of Cancer Therapy–Esophageal, HRQOL, health-related quality of life, QOL, quality of life, SF-36, Short Form–36

CTSNet classification: 7, 8

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 Read at the Eighty-seventh Annual Meeting of The American Association for Thoracic Surgery, Washington, DC, May 5–9, 2007.

PII: S0022-5223(08)01647-4

doi:10.1016/j.jtcvs.2008.09.049

The Journal of Thoracic and Cardiovascular Surgery
Volume 137, Issue 1 , Pages 36-42, January 2009

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