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Health-Related Quality of Life Associated with Barrett’s Esophagus and Cancer

  • Norma B. Bulamu
  • Gang ChenEmail author
  • Julie Ratcliffe
  • Ann Schloite
  • Tim Bright
  • David I. Watson
Original Scientific Report
First Online:
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Abstract

Background

Research assessing health-related quality of life (HRQoL) which can be applied to economic evaluation in Barrett’s esophagus (BE) and esophageal cancer is limited. This study derived health state utilities for various ‘stages’ of BE and Cancer.

Methods

A cross-sectional survey was conducted, including patients with non-dysplastic BE, low-grade dysplasia, high-grade dysplasia, or esophageal adenocarcinoma. HRQoL was assessed using generic instruments—EQ-5D-5L and SF-36, and a cancer-specific instrument—EORTC QLQ-C30. Outcomes were compared for health states following different treatments. Correlations and agreements for the three instruments were investigated using Spearman’s correlation coefficient (r) and intraclass correlation coefficient (ICC).

Results

A total of 97 respondents (80% male, mean age 68 years) returned questionnaires. The mean (standard deviation) health state utilities for the total sample were 0.79 (0.24) for the EQ-5D-5L, 0.57 (0.29) for the SF-6D (derived from SF-36) and 0.73 (0.20) for the QLU-C10D (derived from EORTC QLQ-C30). There were strong correlations (r > 0.80) and absolute agreement (except EQ-5D-5L and SF-6D with an ICC of 0.69) among the three instruments. No significant differences were observed for different stages of BE or interventions. However, following surgery for cancer patients reported better psychological well-being than those under surveillance or following endoscopic treatments.

Conclusion

HRQoL for BE surveillance and following cancer treatment was similar. Esophagectomy was associated with better psychological functioning, and this might be attributed to a reduction in the perceived risk of cancer. The correlation between the EORTC QLU-C10D and the other health state utility instruments supports the validity of this new instrument.

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Notes

Acknowledgements

The authors would like to thank Jeff Bull, Tanya Irvine, and George Mayne for their support.

Funding

Professors Watson and Ratcliffe received a Beat Cancer Hospital Research Package Grant which was funded by the Cancer Council of South Australia’s Beat Cancer Project on behalf of its donors and the State Government of South Australia Department of Health, together with the support of the Flinders Medical Centre Foundation, its donors and partners. This Grant funded Dr. Norma B. Bulamu’s and Dr. Gang Chen’s salary.

Compliance with ethical standards

Conflict of interest

There are no competing interests or conflicts of interests to disclose among the authors.

References

  1. 1.
    Solaymani-Dodaran M, Logan RFA, West J et al (2004) Risk of oesophageal cancer in Barrett’s oesophagus and gastro-oesophageal reflux. Gut 53:1070–1074CrossRefGoogle Scholar
  2. 2.
    Stavrou EP, McElroy HJ, Baker DF et al (2009) Adenocarcinoma of the oesophagus: incidence and survival rates in New South Wales, 1972–2005. Med J Aust 191:310–314Google Scholar
  3. 3.
    Thrift AP, Whiteman DC (2012) The incidence of esophageal adenocarcinoma continues to rise: analysis of period and birth cohort effects on recent trends. Ann Oncol 23:3155–3162CrossRefGoogle Scholar
  4. 4.
    Crockett SD, Lippmann QK, Dellon ES et al (2009) Health-related quality of life in patients with Barrett’s esophagus: a systematic review. Clin Gastroenterol Hepatol 7:613–623CrossRefGoogle Scholar
  5. 5.
    Brazier J, Ratcliffe J, Salomon JA, Tsuchiya A (2016) Measuring and valuing health benefits for economic evaluation. Oxford University Press, OxfordCrossRefGoogle Scholar
  6. 6.
    Wildi SM, Cox MH, Clark LL et al (2004) Assessment of health state utilities and quality of life in patients with malignant esophageal dysphagia. Am J Gastroenterol 99:1044–1049CrossRefGoogle Scholar
  7. 7.
    Hur C, Wittenberg E, Nishioka NS et al (2006) Quality of life in patients with various Barrett’s esophagus associated health states. Health Qual Life Outcomes 4:45CrossRefGoogle Scholar
  8. 8.
    Stein D, Joulain F, Naoshy S et al (2014) Assessing health-state utility values in patients with metastatic colorectal cancer: a utility study in the United Kingdom and the Netherlands. Int J Colorectal Dis 29:1203–1210CrossRefGoogle Scholar
  9. 9.
    Blazeby JM, Kavadas V, Vickery CW et al (2005) A prospective comparison of quality of life measures for patients with esophageal cancer. Qual Life Res 14:387–393CrossRefGoogle Scholar
  10. 10.
    van Reenen M, Janssen B (2015) EQ-5D-5L User guide—basic information on how to use the EQ-5D-5L instrument. EuroQol Research Foundation, RotterdamGoogle Scholar
  11. 11.
    Norman R, Cronin P, Viney R (2013) A pilot discrete choice experiment to explore preferences for EQ-5D-5L health states. Appl health econ health policy 11:287–298CrossRefGoogle Scholar
  12. 12.
    Brazier J, Roberts J, Deverill M (2002) The estimation of a preference-based measure of health from the SF-36. J health econ 21:271–292CrossRefGoogle Scholar
  13. 13.
    Norman R, Viney R, Brazier J et al (2014) Valuing SF-6D health states using a discrete choice experiment. Med Decis Mak Int J Soc Med Decis Mak 34:773–786CrossRefGoogle Scholar
  14. 14.
    Aaronson NK, Ahmedzai S, Bergman B et al (1993) The European organization for research and treatment of cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85:365–376CrossRefGoogle Scholar
  15. 15.
    King MT, Costa DSJ, Aaronson NK et al (2016) QLU-C10D: a health state classification system for a multi-attribute utility measure based on the EORTC QLQ-C30. Qual Life Res 25:625–636CrossRefGoogle Scholar
  16. 16.
    King MT, Viney R, Simon Pickard A et al (2018) Australian utility weights for the EORTC QLU-C10D, a multi-attribute utility instrument derived from the cancer-specific quality of life questionnaire, EORTC QLQ-C30. PharmacoEconomics 36:225–238CrossRefGoogle Scholar
  17. 17.
    Fayers PM, Machin D (2016) Quality of life: the assessment, analysis and interpretation of patient-reported outcomes. Wiley, ChichesterGoogle Scholar
  18. 18.
    Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet (London, England) 1:307–310CrossRefGoogle Scholar
  19. 19.
    StataCorp (2015) Stata Statistical Software: Release 14. College Station, TexasGoogle Scholar
  20. 20.
    Gerson LB, Ullah N, Hastie T et al (2007) Does cancer risk affect health-related quality of life in patients with Barrett’s esophagus? Gastrointest Endosc 65:16–25CrossRefGoogle Scholar
  21. 21.
    Lippmann QK, Crockett SD, Dellon ES et al (2009) Quality of life in GERD and Barrett’s esophagus is related to gender and manifestation of disease. Am J Gastroenterol 104:2695–2703CrossRefGoogle Scholar
  22. 22.
    Essink-Bot M-L, Kruijshaar ME, Bac DJ et al (2007) Different perceptions of the burden of upper GI endoscopy: an empirical study in three patient groups. Qual Life Res 16:1309–1318CrossRefGoogle Scholar
  23. 23.
    Shaheen NJ, Peery AF, Hawes RH et al (2010) Quality of life following radiofrequency ablation of dysplastic Barrett’s esophagus. Endoscopy 42:790–799CrossRefGoogle Scholar
  24. 24.
    Scarpa M, Valente S, Alfieri R et al (2011) Systematic review of health-related quality of life after esophagectomy for esophageal cancer. World J Gastroenterol 17:4660–4674CrossRefGoogle Scholar
  25. 25.
    Rosmolen WD, Boer KR, de Leeuw RJ et al (2010) Quality of life and fear of cancer recurrence after endoscopic and surgical treatment for early neoplasia in Barrett’s esophagus. Endoscopy 42:525–531CrossRefGoogle Scholar
  26. 26.
    Breetvelt IS, Van Dam FSAM (1991) Underreporting by cancer patients: the case of response-shift. Soc Sci Med 32:981–987CrossRefGoogle Scholar
  27. 27.
    Sprangers MAG, Schwartz CE (1999) The challenge of response shift for quality-of-life-based clinical oncology research. Ann Oncol 10:747–749CrossRefGoogle Scholar
  28. 28.
    Aburub AS, Gagnon B, Ahmed S et al (2018) Impact of reconceptualization response shift on rating of quality of life over time among people with advanced cancer. Support Care Cancer 26:3063–3071CrossRefGoogle Scholar
  29. 29.
    Jansen SJ, Stiggelbout AM, Nooij MA et al (2000) Response shift in quality of life measurement in early-stage breast cancer patients undergoing radiotherapy. Qual Life Res 9:603–615CrossRefGoogle Scholar
  30. 30.
    Rees J, Clarke MG, Waldron D et al (2005) The measurement of response shift in patients with advanced prostate cancer and their partners. Health Qual Life Outcomes 3:21CrossRefGoogle Scholar
  31. 31.
    Scarpa M, Saadeh LM, Fasolo A et al (2013) Health-related quality of life in patients with oesophageal cancer: analysis at different steps of the treatment pathway. J Gastrointest Surg 17:421–433CrossRefGoogle Scholar
  32. 32.
    Barbour AP, Lagergren P, Hughes R et al (2008) Health-related quality of life among patients with adenocarcinoma of the gastro-oesophageal junction treated by gastrectomy or oesophagectomy. Br J Surg 95:80–84CrossRefGoogle Scholar
  33. 33.
    Malmstrom M, Klefsgard R, Ivarsson B et al (2015) Quality of life measurements as an indicator for timing of support after oesophagectomy for cancer: a prospective study. BMC Health Serv Res 15:96CrossRefGoogle Scholar
  34. 34.
    Nafteux P, Durnez J, Moons J et al (2013) Assessing the relationships between health-related quality of life and postoperative length of hospital stay after oesophagectomy for cancer of the oesophagus and the gastro-oesophageal junction. Eur J Cardiothorac Surg 44:525–533CrossRefGoogle Scholar
  35. 35.
    Haj Mohammad N, De Rooij S, Hulshof M et al (2016) Activities of daily living and quality of life during treatment with neoadjuvant chemoradiotherapy and after surgery in patients with esophageal cancer. J Surg Oncol 114:684–690CrossRefGoogle Scholar
  36. 36.
    Donohoe CL, McGillycuddy E, Reynolds JV (2011) Long-term health-related quality of life for disease-free esophageal cancer patients. World J Surg 35:1853–1860CrossRefGoogle Scholar
  37. 37.
    Fuchs H, Holscher AH, Leers J et al (2016) Long-term quality of life after surgery for adenocarcinoma of the esophagogastric junction: extended gastrectomy or transthoracic esophagectomy? Gastric Cancer 19:312–317CrossRefGoogle Scholar
  38. 38.
    Gutschow CA, Holscher AH, Leers J et al (2013) Health-related quality of life after Ivor Lewis esophagectomy. Langenbecks Arch Surg 398:231–237CrossRefGoogle Scholar
  39. 39.
    van Meerten E, van der Gaast A, Looman CW et al (2008) Quality of life during neoadjuvant treatment and after surgery for resectable esophageal carcinoma. Int J Radiat Oncol Biol Phys 71:160–166CrossRefGoogle Scholar
  40. 40.
    Akkerman RD, Haverkamp L, van Rossum PS et al (2015) Long-term quality of life after oesophagectomy with gastric conduit interposition for cancer. Eur J Cancer 51:1538–1545CrossRefGoogle Scholar
  41. 41.
    Daster S, Soysal SD, Stoll L et al (2014) Long-term quality of life after Ivor Lewis esophagectomy for esophageal cancer. World J Surg 38:2345–2351CrossRefGoogle Scholar
  42. 42.
    Derogar M, Lagergren P (2012) Health-related quality of life among 5-year survivors of esophageal cancer surgery: a prospective population-based study. J Clin Oncol 30:413–418CrossRefGoogle Scholar
  43. 43.
    Wormald JC, Bennett J, van Leuven M et al (2016) Does the site of anastomosis for esophagectomy affect long-term quality of life? Dis Esophagus 29:93–98CrossRefGoogle Scholar
  44. 44.
    Li S, Wang M, Liu L, et al (2018) Which approach is better in eliciting health state utilities from breast cancer patients? evidence from mainland China. Eur J Cancer Care.  https://doi.org/10.1111/ecc.12965 Google Scholar

Copyright information

© Société Internationale de Chirurgie 2019

Authors and Affiliations

  1. 1.Flinders Centre for Innovation in Cancer, College of Medicine and Public HealthFlinders UniversityAdelaideAustralia
  2. 2.Centre for Health Economics, Monash Business SchoolMonash UniversityMelbourneAustralia
  3. 3.Institute of Choice, Business SchoolUniversity of South AustraliaAdelaideAustralia
  4. 4.Discipline of Surgery, College of Medicine and Public HealthFlinders UniversityAdelaideAustralia

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