# LAsting Symptoms after Oesophageal Resectional Surgery (LASORS): multicentre validation cohort study

## TL;DR

This study validates a six-symptom tool to identify patients with poor quality of life after oesophageal cancer surgery, showing it is accurate and useful for clinical follow-up.

## Contribution

The first prospectively validated tool for identifying poor health-related quality of life in post-esophagectomy patients.

## Key findings

- Four LASORS symptoms (reduced energy, low mood, diarrhea, bloating) were significantly associated with poor quality of life.
- The LASORS tool demonstrated good diagnostic accuracy with an area under the curve of 0.858.
- The tool is practical for identifying at-risk patients and guiding survivorship care.

## Abstract

Long-term symptom burden and health-related quality-of-life outcomes after curative oesophageal cancer treatment are poorly understood. Existing tools are cumbersome and do not address the post-treatment population specifically. The aim of this study was to validate the six-symptom LASORS tool for identifying patients after curative oesophageal cancer treatment with poor health-related quality of life and to assess its clinical utility.

Between 2015 and 2019, patients from 15 UK centres who underwent curative-intent oesophageal cancer treatment, and were disease-free at least 1 year after surgery, were invited to participate in the study and complete LASORS and European Organisation for Research and Treatment of Cancer QLQ-C30 and QLQ-OG25 questionnaires. Receiver operating characteristic curve analysis was used to examine the accuracy of the LASORS tool for identifying patients with poor health-related quality of life.

A total of 263 patients completed the questionnaire. Four of the six LASORS symptoms were associated with poor health-related quality of life: reduced energy (OR 2.13 (95% c.i. 1.45 to 3.13)); low mood (OR 1.86 (95% c.i. 1.20 to 2.88)); diarrhoea more than three times a day unrelated to eating (OR 1.48 (95% c.i. 1.06 to 2.07)); and bloating or cramping after eating (OR 1.35 (95% c.i. 1.03 to 1.77)). The LASORS tool showed good diagnostic accuracy with an area under the receiver operating characteristic curve of 0.858 for identifying patients with poor health-related quality of life.

The six-symptom LASORS tool generated a reliable model for identification of patients with poor health-related quality of life after curative treatment for oesophageal cancer. This is the first tool of its kind to be prospectively validated in the post-esophagectomy population. Clinical utility lies in identification of patients at risk of poor health-related quality of life, ease of use of the tool, and in planning survivorship services.

This study is the culmination of the previously published LASER study research, which identified a core set of symptoms associated with poor health-related quality of life. In this study the authors went on and prospectively validated the six-symptom LASORS tool in a UK cohort of patients and demonstrated good accuracy with an area under the receiver operating characteristic curve of 0.858. The importance of this study is that it provides validation of the LASORS tool, which can potentially be used in clinical practice to guide follow-up of patients after oesophagectomy with more appropriate allocation to survivorship clinics.