Skip to main content

Advertisement

SpringerLink
Log in

Quality-of-life measures as predictors of post-esophagectomy survival of patients with esophageal cancer

  • Published:
Quality of Life Research Aims and scope Submit manuscript

Abstract

Purpose

Improving survival after esophagectomy is an important issue in treating patients with esophageal cancer (EC). In addition to standard hospitalization management, periodic assessment of quality-of-life (QOL) measures may be useful to detect disease progression from patients’ subjective reports. Therefore, this prospective longitudinal study was undertaken to identify prognostic factors for 3-year survival of EC patients after esophagectomy and to evaluate the impact of QOL measures on these prognostic factors.

Methods

Patients with EC (n = 67) who had a complete tumor resection and were alive 6 months after esophagectomy were followed in this study for 3 years. Data were collected on patients’ sociodemographics, cancer characteristics, adjuvant therapy, general QOL and EC-specific QOL (before esophagectomy and 6 months afterward), cancer recurrence, and death. Patients’ independent risk factors for 3-year survival were investigated by multivariate Cox regression analysis.

Results

Of the 67 participants with EC, 26 had late mortality, with a median survival for the whole cohort of 38.2 months (95 % CI 31.97–44.35). Independent predictors of early death were early cancer recurrence (within 6 months after surgery), poor cognitive function (95 % CI 1.020–1.041), and worse dyspnea (95 % CI 1.007–1.034).

Conclusions

The most predictive factor for early death in EC patients after esophagectomy was cancer recurrence within 6 months after surgery. However, QOL measures could be a tool to provide clinical information from patients’ perspective suggesting cancer recurrence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Zhang, Y. (2013). Epidemiology of esophageal cancer. World Journal of Gastroenterology, 19, 598–606. doi:10.3748/wjg.v19.i34.5598.

    CAS  Google Scholar 

  2. Montgomery, E. A., Basman, F. T., Brennan, P., & Malekzadeh, R. (2014). Oesophageal cancer. In B. W. Stewart & C. P. Wild (Eds.), World cancer report 2014 (pp. 528–543). Geneva: World Health Organization.

    Google Scholar 

  3. Lu, C. L., Lang, H. C., Luo, J. C., Liu, C. C., Lin, H. C., Chang, F. Y., et al. (2010). Increasing trend of the incidence of esophageal squamous cell carcinoma, but not adenocarcinoma, in Taiwan. Cancer Causes and Control, 21, 269–274. doi:10.1007/s10552-009-9458-0.

    Article  PubMed  Google Scholar 

  4. Graham, A. J., Shrive, F. M., Ghali, W. A., Manns, B. J., Grondin, S. C., Finley, R. J., et al. (2007). Defining the optimal treatment of locally advanced esophageal cancer: A systematic review and decision analysis. Annals of Thoracic Surgery, 83, 1257–1264.

    Article  PubMed  Google Scholar 

  5. Orringer, M. B., Marshall, B., Chang, A. C., Lee, J., Rickens, A., & Lau, C. L. (2007). Two thousand transhiatal esophagectomies. Annals of Surgery, 246, 363–374.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Reynolds, J. V., McLaughlin, R. J., Moore, S., Rowley, N. R., & Byrne, P. J. (2006). Prospective evaluation of quality of life in patients with localized oesophageal cancer treated by multimodality therapy or surgery alone. British Journal of Surgery, 93, 1084–1090.

    Article  CAS  PubMed  Google Scholar 

  7. Safieddine, N., Xu, W., Quadri, S. M., Knox, J. J., Hornby, J., Sulman, J., et al. (2009). Health-related quality of life in esophageal cancer: Effect of neoadjuvant chemoradiotherapy followed by surgical intervention. Journal of Thoracic Cardiovascular Surgery, 137, 36–42.

    Article  PubMed  Google Scholar 

  8. Davies, A. R., Pillai, A., Sinha, P., Sandhu, H., Adeniran, A., Mattsson, F., et al. (2014). Factors associated with early recurrence and death after esophagectomy for cancer. Journal of Surgical Oncology, 109, 459–464.

    Article  PubMed  Google Scholar 

  9. Kosugi, S. I., Kanda, T., Yajima, K., Ishikawa, T., & Hatakeyama, K. (2011). Risk factors that influence early death due to cancer recurrence after extended radical esophagectomy with three-field lymph node dissection. Annals of Surgical Oncology, 18, 2961–2967.

    Article  PubMed  Google Scholar 

  10. Mariette, C., Balon, J. M., Piessen, G., Fabre, S., Van Seuningen, I., & Triboulet, J. P. (2003). Pattern of recurrence following complete resection of esophageal carcinoma and factors predictive of recurrent disease. Cancer, 97, 1616–1623. doi:10.1002/cncr.11228.

    Article  PubMed  Google Scholar 

  11. Montazeri, A., Milroy, R., Hole, D., McEwen, J., & Gillis, C. R. (2003). How quality of life data contribute to our understanding of cancer patients’ experiences? A study of patients with lung cancer. Quality of Life Research, 12, 157–166.

    Article  PubMed  Google Scholar 

  12. Quinten, C., Coens, C., Mauer, M., Comte, S., Sprangers, M. A., Cleeland, C., et al. (2009). Baseline quality of life as a prognostic indicator of survival: A meta-analysis of individual patient data from EORTC clinical trials. Lancet Oncology, 10, 865–871. doi:10.1016/S1470-2045(09)70200-1.

    Article  PubMed  Google Scholar 

  13. Montazeri, A. (2009). Quality of life data as prognostic indicators of survival in cancer patients: An overview of the literature from 1982 to 2008. Health and Quality of Life Outcomes, 7, 102. doi:10.1186/1477-7525-7-102.

    Article  PubMed Central  PubMed  Google Scholar 

  14. Van Heijl, M., Sprangers, M. A. G., de Boer, A. G. E., Lagarde, S. M., Reitsma, H. B., Busch, O. R. C., et al. (2010). Preoperative and early postoperative quality of life predict survival in potentially curable patient with esophageal cancer. Annals of Surgical Oncology, 17, 23–30. doi:10.1245/s10434-009-0731-y.

    Article  PubMed Central  PubMed  Google Scholar 

  15. Grande, G. E., Farquhar, M. C., Barclay, S. I. G., & Todd, C. J. (2009). Quality of life measures (EORTC QLQ-C30 and SF-36) as predictors of survival in palliative colorectal and lung cancer patients. Palliative and Supportive Care, 7, 289–297.

    Article  PubMed  Google Scholar 

  16. Djärv, T., & Lagergren, P. (2011). Six-month postoperative quality of life predicts long-term survival after oesophageal cancer surgery. European Journal of Cancer, 47, 530–535.

    Article  PubMed  Google Scholar 

  17. McKernan, M., McMillan, D. C., Anderson, J. R., Angerson, W. J., & Stuart, R. C. (2008). The relationship between quality of life (EORTC QLQ-C30) and survival in patients with gastro-oesophageal cancer. British Journal of Cancer, 98, 888–893.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  18. Sundaram, A., Geronimo, J. C., Willer, B. L., Hoshino, M., Torgersen, Z., Juhasz, A., et al. (2012). Survival and quality of life after minimally invasive esophagectomy: A single-surgeon experience. Surgical Endoscopy, 26, 168–176.

    Article  PubMed  Google Scholar 

  19. Gillham, C. M., Aherne, N., Rowley, S., Moore, J., Hollywood, D., O’Byrne, K., et al. (2008). Quality of life and survival in patients treated with radical chemoradiation alone for oesophageal cancer. Clinical Oncology, 20, 227–233.

    Article  CAS  PubMed  Google Scholar 

  20. Scarpa, M., Valente, S., Alfieri, R., Cagol, M., Diamantis, G., Ancona, E., et al. (2011). Systematic review of health-related quality of life after esophagectomy for esophageal cancer. World Journal of Gastroenterology, 17, 4660–4674.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Viklund, P., Wengstrőm, Y., Rouvelas, I., Lindblad, M., & Lagergren, J. (2006). Quality of life and persisting symptoms after oesophageal cancer surgery. European Journal of Cancer, 42, 1407–1414. doi:10.1016/j.ejca.2006.02.005.

    Article  PubMed  Google Scholar 

  22. Chang, Y. L., Tsai, Y. F., Wu, Y. C., & Hsieh, M. J. (2014). Factors relating to quality of life after esophagectomy for cancer patients in Taiwan. Cancer Nursing, 37, 4–13. doi:10.1097/NCC.0b013e318277dc53.

    Article  PubMed  Google Scholar 

  23. Courrech Staal, E. F., van Sandick, J. W., van Tinteren, H., Cats, A., & Aaronson, N. K. (2010). Health-related quality of life in long-term esophageal cancer survivors after potentially curative treatment. Journal of Thoracic Cardiovascular Surgery, 140, 777–783. doi:10.1016/j.jtcvs.2010.05.018.

    Article  PubMed  Google Scholar 

  24. Healy, L. A., Ryan, A. M., Moore, J., Rowley, S., Ravi, N., Byrne, P. J., et al. (2008). Health-related quality of life assessment at presentation may predict complications and early relapse in patient with localized cancer of the esophagus. Diseases of the Esophagus, 21, 522–528. doi:10.1111/j.1442-2050.2008.00814.x.

    Article  CAS  PubMed  Google Scholar 

  25. American Joint Committee on Cancer. (2010). Cancer staging manual (7th ed., pp. 29–40). New York: Springer.

    Book  Google Scholar 

  26. Lerut, T., Moons, J., Coosemans, W., Van Raemdonck, D., De Leyn, P., Decaluwé, H., et al. (2009). Postoperative complications after transthoracic esophagectomy for cancer of the esophagus and gastroesophageal junction are correlated with early cancer recurrence. Annals of Surgery, 250, 798–807. doi:10.1097/SLA.0b013e3181bdd5a8.

    Article  PubMed  Google Scholar 

  27. Chie, W. C., Hong, R. L., Lai, C. C., Ting, L. L., & Hsu, M. M. (2003). Quality of Life in patients with nasopharyngeal carcinoma: Validation of the Taiwan Chinese version of the EORTC QLQC30 and the EORTC QLQ-H&N35. Quality of Life Research, 12, 93–98.

    Article  CAS  PubMed  Google Scholar 

  28. Chie, W. C., Tsai, C. J., Chiang, C., & Lee, Y. C. (2010). Quality of life of patients with oesophageal cancer in Taiwan: Validation and application of the Taiwan Chinese (Mandarin) version of the EORTC QLQ-OES18: A brief communication. Quality of Life Research, 19, 1127–1131.

    Article  PubMed  Google Scholar 

  29. Fayers, P., Aaronson, N. K., Bjordal, K., Groenvold, M., Curran, D., & Bottomley, A. (2001). The EORTC QLQ-C30 scoring manual (3rd ed.). Brussels: European Organization for Research and Treatment of Cancer.

    Google Scholar 

  30. Cox, D., & Oakes, D. (1984). Analysis of survival data. London: Chapman and Hall.

    Google Scholar 

  31. Campbell, M. J. (2001). Statistics at square two: Understanding modern statistical applications in medicine. London: BMJ Books.

    Google Scholar 

  32. Grotenhuis, B. A., Wijnhoven, B. P. L., Hötte, G. J., van der Stok, E. P., Tilanus, H. W., & Lanschot, J. J. B. (2010). Prognostic value of body mass index on short-term and long-term outcome after resection of esophageal cancer. World Journal of Surgery, 34, 2621–2627. doi:10.1007/s00268-010-0697-8.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  33. Atkins, B. Z., Shah, A. S., Hutcheson, K. A., Mangum, J. H., Pappas, T. N., Harpole, D. H, Jr, et al. (2004). Reducing hospital morbidity and mortality following esophagectomy. Annals of Thoracic Surgery, 78(4), 1170–1176.

    Article  PubMed  Google Scholar 

  34. Ancona, E., Cagol, M., Epifani, M., Cavallin, F., Zaninotto, G., Castoro, C., et al. (2006). Surgical complications do not affect long-term survival after esophagectomy for carcinoma of the thoracic esophagus and cardia. Journal of the American College of Surgeons, 203(5), 661–669.

    Article  PubMed  Google Scholar 

  35. Luc, G., Durand, M., Chiche, L., & Collet, D. (2015). Major post-operative complications predict long-term survival after esophagectomy in patients with adenocarcinoma of the esophagus. World Journal of Surgery, 391, 216–222.

    Article  Google Scholar 

  36. Schieman, C., Wigle, D. A., & Deschamps, C. (2012). Patterns of operative mortality following esophagectomy. Diseases of the Esophagus, 25, 645.

    Article  CAS  PubMed  Google Scholar 

  37. Blazeby, J. M., Sanford, E., Falk, S. J., Aldersosn, D., & Donovan, J. L. (2005). Health-related quality of life during neoadjuvant treatment and surgery for localized esophageal carcinoma. Cancer, 103, 1791–1799.

    Article  PubMed  Google Scholar 

  38. Department of Health of Taiwan, Taipei, Taiwan. Health statistics. http://www.doh.gov.tw. Accessed May 18, 2015.

  39. Chou, Q., Hong, J., & Chou, P. (1997). Prevalence of cigarettes smoking and betel nut chewing in Taiwan. Chinese Journal of Dental Research, 16, 28–36.

    Google Scholar 

  40. Hwu, H. G., Yeh, E. K., Yeh, Y. L., & Chang, L. Y. (1988). Alcoholism by Chinese diagnostic interview schedule: A prevalence and validity study. Acta Psychiatrica Scandinavica, 77, 7–13.

    Article  CAS  PubMed  Google Scholar 

  41. Wu, I. C., Lu, C. Y., & Kuo, F. C. (2006). Interaction between cigarette, alcohol and betel nut use on esophageal cancer risk in Taiwan. European Journal of Clinical Investigation, 36, 236–241.

    Article  CAS  PubMed  Google Scholar 

  42. Speicher, P. J., Englum, B. R., Ganapathi, A. M., Mulvihill, M. S., Hartwig, M. G., Onaitis, M. W., et al. (2015). Adjuvant chemotherapy is associated with improved survival after esophagectomy without induction therapy for node-positive adenocarcinoma. Journal of Thoracic Oncology, 10, 181–188.

    Article  CAS  PubMed  Google Scholar 

  43. Fang, F. M., Tsai, W. L., Chiu, H. C., Kuo, W. R., & Hsiung, C. Y. (2003). Quality of life as a survival predictor for esophageal squamous cell carcinoma treated with radiotherapy. International Journal of Radiation Oncology, Biology, & Physics, 58(5), 1394–1404. doi:10.1016/j.ijrobp.2003.09.100.

    Article  Google Scholar 

  44. Lou, F., Sima, C. S., Adusumilli, P. S., Bains, M. S., Sarkaria, I. S., Rusch, V. W., et al. (2013). Esophageal cancer recurrence patterns and implications for surveillance. Journal of Thoracic Oncology, 8, 1558–1562.

    Article  PubMed Central  PubMed  Google Scholar 

  45. Almhanna, K., Shridhar, R., & Meredith, K. L. (2013). Neoadjuvant or adjuvant therapy for resectable esophageal cancer: Is there a standard of care? Cancer Control, 20, 89–96.

    PubMed  Google Scholar 

  46. Ku, G. Y., & Ilson, D. H. (2007). Esophageal cancer: Adjuvant therapy. Cancer Journal, 13, 162–167.

    Article  CAS  Google Scholar 

  47. Gysels, M., Bausewein, C., & Higginson, I. J. (2007). Experiences of breathlessness: A systematic review of the qualitative literature. Palliative and Supportive Care, 5, 281–302.

    Article  PubMed  Google Scholar 

  48. Carrieri-Kohlman, V. (2006). Non-pharmacologic approaches. In S. Booth & D. Dudgeon (Eds.), Dyspnoea in advanced disease: A guide to clinical management (p. 171). New York: Oxford University Press.

    Google Scholar 

  49. Zhao, I., & Yates, P. (2008). Non-pharmacological interventions for breathlessness management in patients with lung cancer: A systematic review. Palliative Medicine, 22, 693–701.

    Article  CAS  PubMed  Google Scholar 

  50. Ahles, T. A. (2012). Brain vulnerability to chemotherapy toxicities. Psychooncology, 21, 1141–1148.

    Article  PubMed Central  PubMed  Google Scholar 

  51. Jim, H. S., Phillips, K. M., Chait, S., Faul, L. A., Popa, M. A., Lee, Y. H., et al. (2012). Meta-analysis of cognitive functioning in breast cancer survivors previously treated with standard-dose chemotherapy. Journal of Clinical Oncology, 30, 3578–3587.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  52. Wefel, J. S., Collins, R., & Kayl, A. E. (2008). Cognitive dysfunction related to chemotherapy and biological response modifiers. In C. A. Myers & J. R. Perry (Eds.), Cognition and cancer (p. 97). Cambridge: Cambridge University Press.

    Chapter  Google Scholar 

  53. Hurria, A., Somlo, G., & Ahles, T. (2007). Renaming “chemobrain”. Cancer Investigation, 25, 373–377.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Nursing, Chang Gung Memorial Hospital, Linkou, Tao-Yuan, Taiwan

    Yu-Ling Chang

  2. Graduate Institute of Clinical Medical Sciences, Chang Gung University, Tao-Yuan, Taiwan

    Yu-Ling Chang

  3. School of Nursing, College of Medicine, Chang Gung University, 259, Wen-Hwa 1st Road, Tao-Yuan, 333, Taiwan

    Yun-Fang Tsai

  4. Department of Nursing, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan

    Yun-Fang Tsai

  5. Department of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan

    Yin-Kai Chao

  6. Department of Cardiovascular Surgery, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan

    Meng-Yu Wu

Authors
  1. Yu-Ling Chang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yun-Fang Tsai
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yin-Kai Chao
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Meng-Yu Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yun-Fang Tsai.

Ethics declarations

Conflict of interest

The authors declare no conflict of interest or commercial interests regarding this study.

Ethical approval

All procedures performed in this study on human participants were in accordance with the ethical standards of the study site’s research ethics committee and with the 1964 Helsinki Declaration and its later amendments.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chang, YL., Tsai, YF., Chao, YK. et al. Quality-of-life measures as predictors of post-esophagectomy survival of patients with esophageal cancer. Qual Life Res 25, 465–475 (2016). https://doi.org/10.1007/s11136-015-1094-4

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11136-015-1094-4

Keywords

Search

Navigation