Health-related quality of life after oesophageal cancer surgery for prediction of morbidity and mortality

This thesis investigates the health-related quality of life (HRQL) among surgically treated oesophageal cancer patients. The established curative treatment for oesophageal cancer is extensive surgery with a high risk of morbidity and a limited chance of long-term survival. Only every third patient is suitable for surgery. Subjective outcomes such as HRQL are therefore of particular importance among this group of patients.

In three of the four studies (I, II, IV) included in this thesis, a nationwide Swedish cohort of oesophageal cancer patients, operated in 2001-2005, was used, while in study III a British cohort of operated patients was used. In all studies, HRQL was assessed with an international validated core questionnaire on the symptoms and functions of cancer (EORTC QLQ-C30). Studies I, II and IV also included an oesophageal cancer specific module (EORTC QLQ-OES18). In Studies I and III a difference in transformed mean scores of at least 10 points on a scale of 0-100 was used as a cut-off for clinical relevance. In Studies II and IV raw scores were categorised into good or poor HRQL.

In Study I, the long term HRQL after oesophageal cancer surgery was investigated. HRQL was shown to be similar both six months and three years postoperatively, which suggests that the long-standing HRQL level is already established at six months. The HRQL was poorer than that of the general population.

Study II assessed if patient and tumour characteristics affect HRQL six months postoperatively. Sex, age and BMI showed no associations while co-morbidity and tumour characteristics such as histology and tumour stage affected HRQL. The findings may be useful for clinical decision making. Study III explored if both baseline HRQL and changes in HRQL from baseline to six months followup was associated with survival. Dyspnoea at baseline was associated with an increased risk of mortality. Not recovering physical function and worsening of pain and fatigue were linked with a higher risk of mortality. Therefore, changes in HRQL might be prognostic and of importance when planning follow-up and supportive care.

Study IV analysed whether postoperative HRQL was associated with survival. Poor HRQL measures were associated with increased risk of mortality. This knowledge could be used for prognostic discussions and intensity of the clinical follow-up.

In conclusion, this thesis shows that measures of HRQL could aid decision-making prior to treatment and in planning the follow-up of osesophageal cancer patients.

List of scientific papers

I. Djärv T, Lagergren J, Blazeby JM, Lagergren P (2008). "Long-term health-related quality of life following surgery for oesophageal cancer." Br J Surg 95: 1121-1126
https://pubmed.ncbi.nlm.nih.gov/18581441

II. Djärv T, Blazeby JM, Lagergren P (2009). "Predictors of postoperative quality of life after esophagectomy for cancer." J Clin Oncol 27: 1963-1968
https://pubmed.ncbi.nlm.nih.gov/

19289614

III. Djärv T, Metcalfe C, Avery KN, Lagergren P, Blazeby JM (2010). "Prognostic value of changes in health-related quality of life scores during curative treatment for esophagogastric cancer." J Clin Oncol 28: 1666-1670
https://pubmed.ncbi.nlm.nih.gov/

20194863

IV. Djärv T, Lagergren P (2010). "Postoperative quality of life associated with survival in oesophageal cancer patients." (Submitted)