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J Thorac Cardiovasc Surg 2009;137:36-42
© 2009 The American Association for Thoracic Surgery

General Thoracic Surgery

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

Najib Safieddine, MDa, Wei Xu, PhDb, Sayed Mohammed Quadri, MD, FRCSCc, Jennifer J. Knox, MD, FRCPd, Jennifer Hornby, BSc, CCRPa, Joanne Sulman, MSWe, Rebecca Wong, MD, FRCPf, Maha Guindi, MD, FRCPg, Shaf Keshavjee, MD, MSc, FRCSC, FACSa, Gail Darling, MD, FRCSC, FACSa,*

a Division of Thoracic Surgery, Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
b Department of Biostatistics, Public Health Sciences, University of Toronto, Toronto, Ontario, Canada
c Division of Thoracic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
d Department of Medicine, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada
e Department of Social Work, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
f Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada
g Department of Pathology, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada

Received for publication March 29, 2007; revisions received September 24, 2008; accepted for publication September 30, 2008.

* Address for reprints: Gail Darling, MD, FRCSC, FACS, Toronto General Hospital, Division of Thoracic Surgery, 9N-955, 200 Elizabeth St, Toronto, Ontario M5G 2C4, Canada. (Email: gail.darling{at}uhn.on.ca).

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




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