259 FEATURES PREDICTING WORSE POSTOPERATIVE HEALTH-RELATED QUALITY OF LIFE IN PATIENTS WITH ESOPHAGEAL CANCER: RESULTS FROM THE CROSS-TRIAL

Abstract

Abstract Currently, trials are investigating active surveillance in esophageal cancer compared to standard esophagectomy after neoadjuvant chemoradiotherapy (nCRT). If non-inferiority is reported, on patients the choice will be imposed choice between active surveillance or immediate esophagectomy. The aim of this study was to identify clinical- and tumor characteristics that are predictive for a worse health-related quality of life (HR-QoL) after esophagectomy. Methods HR-QoL was measured using EORTC-QLQ-C30 and QLQ-OES24 questionnaires prior treatment and three, six, nine and twelve months postoperatively. Subgroups were predefined from patients with different clinical (global HR-QoL, WHO-status) and tumor characteristics (histology, disease stage and location of the tumor). High and low global HR-QoL were defined as global health scores ≥75 and < 75, respectively. Cohen’s d effect-sizes were determined, 0.5–0.8 was considered a medium and > 0.8 considered a large effect. The primary endpoints were physical functioning and eating problems. Secondary endpoints were global HRQOL, fatigue and emotional problems. Exploratory, the effect of age and gender on HR-QoL was assessed. Results In total, 363 patients received HR-QoL questionnaires. Patients who reported a high global HR-QoL prior treatment had a significantly worse deterioration in HR-QoL after esophagectomy than patients who reported a low HR-QoL prior treatment, on all endpoints except for physical functioning. Corresponding Cohen’s d scores were 0.85 for eating problems, −1.25 for global HR-QoL, 0.75 for fatigue and 0.65 for emotional problems. No additional differences between subgroups were identified. All predefined subgroups had impaired HR-QoL up to twelve months postoperatively for both physical functioning and fatigue with a medium to large Cohen’s d effect size. Conclusion Patients reporting high global HR-QoL prior treatent have worse deteriotation in HR-QoL than patients reporting low global HR-QoL prior treatment. No additional characteristics were identified that were predictive for worse HR-QoL after esophagectomy. This emphazises the need for shared-decision making in case active surveillance proves non-inferior compared to standard esophagectomy. All subgroups had deterioration in physical functioning and eating problems up to twelve months postoperatively.