Frailty and Health-Related Quality of Life in Elderly Patients Undergoing Esophageal Cancer Surgery: A Longitudinal Study

Abstract

PurposeThis study aims to elucidate the longitudinal alterations in frailty and health-related quality of life experienced by elderly patients undergoing surgical treatment for esophageal cancer. Additionally, it seeks to ascertain the impact of preoperative frailty on postoperative health-related quality of life over time. Methods131 patients were included in the prospective study. Patients' frailty and health-related quality of life were assessed utilizing the Tilburg and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC-QLQ-C30) at preoperative, 1 week, 1-month, and 3 months postoperatively. Statistical analyses were performed using generalized estimating equations (GEE), repeated-measures analysis of variance (ANOVA), and linear mixed models (LMMs). ResultsOut of 131 patients, 28.2% had frailty before surgery, and the prevalence of frailty consistently higher after surgery compared to baseline (67.9%, 51.9%, 39.7%). There was no significant change in frailty scores in preoperative frail patients within 3 months following surgery (P= .496, P< .999, P< .999); whereas in preoperative non-frail patients, the frailty scores increased at 1 week (P< .001) and then decreased at 1-month (P= .014), followed by no change at 3 months. In addition, preoperative frail patients had significantly worse global quality of life (QL) (β=-4.24(-8.31; -.18), P= .041), physical functioning (β=-9.87(-14.59; -5.16), P< .001), role functioning (β=-10.04(-15.76; -4.33), P= .001) and social functioning (β=-8.58(-15.49; -1.68), P= .015), compared to non-frail patients. ConclusionsA significant proportion of participants exhibited a high prevalence of preoperative frailty. These patients, who were preoperatively frail, exhibited a marked reduction in health-related quality of life, a more gradual recovery across various functional domains, and an increased symptom burden during the follow-up period. Therefore, it is crucial to meticulously identify and closely monitor patients with preoperative frailty for any changes in their postoperative physiology, role, and social functioning.