Health-related quality of life after definitive chemoradiotherapy in patients with esophageal carcinoma: a population-based analysis

TL;DR

This study examines how health-related quality of life changes in esophageal cancer patients undergoing chemoradiotherapy, finding that while some aspects recover, physical and role functioning remain impaired.

Contribution

A population-based analysis of HRQoL outcomes after definitive chemoradiotherapy for locally advanced esophageal cancer in a real-world setting.

Findings

Global health status remained stable from 6 months after treatment.

Physical and role functioning, fatigue, and dyspnea remained impaired for up to 2 years.

Social and cognitive functioning initially declined but recovered to baseline levels by 6 months.

Abstract

Definitive chemoradiotherapy (dCRT) can achieve durable local control and even cure in patients with locally advanced esophageal cancer. However, survival benefit may be accompanied by a decline in health-related quality of life (HRQoL) owing to experienced adverse effects. This study aims to investigate HRQoL in patients with locally advanced esophageal cancer receiving dCRT in a real-world setting.

Patients with locally advanced esophageal squamous cell carcinoma or adenocarcinoma receiving dCRT (≥ 50.4 Gy/28 fractions with concomitant weekly chemotherapy) were eligible. Patient-reported outcome measures were prospectively collected using the validated questionnaires EORTC-QLQ-C30 and EORTC-QLQ-OG25 at baseline and every 3 months thereafter for 2 years. Clinical data were obtained from the Netherlands Cancer Registry. Longitudinal HRQoL outcomes were compared to baseline using mixed effect models.

318 patients were included with a median age of 70 years. The total number of available questionnaires across all timepoints was 718. Out of 318 alive patients, 223 (70.1%) returned a questionnaire at baseline, which declined to 71 out of 195 (36.4%) at 2 years. Global health status at baseline was 70.6 (95% CI 68.1–73.1) and remained stable over time. Patients reported significantly lower physical (-13.0), role (-18.9), cognitive (-6.6), and social functioning (-14.4) at 3 months compared to baseline (all p < 0.0001). Social and cognitive functioning scores recovered to baseline level at 6 months. Physical and role functioning, and the symptom scales fatigue and dyspnea, remained impaired until 2 years after baseline. Significant improvements were observed for anxiety, eating restrictions, odynophagia and dysphagia at nearly all time points, but most pronounced at 12 or 18 months.

Our study showed that where global health status remained stable from 6 months after dCRT, the burden of disease-specific symptoms decreased. Social and cognitive functioning first deteriorated but recovered over time, whereas the decline in physical functioning, role functioning, fatigue and dyspnea did not recover to baseline level. These findings can provide valuable insights to address concerns regarding the impact of dCRT on HRQoL within the context of shared decision-making.

The online version contains supplementary material available at 10.1007/s00520-026-10450-2.

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