Is it time for quality time? Intensive medical oncology follow-up during treatment for esophageal adenocarcinoma.

Abstract

29 Background: Concurrent chemotherapy and radiation for esophageal cancer patients is morbid with many potential complications. The efficacy of intensive patient follow up by medical oncology during concurrent treatment was retrospectively evaluated at our cancer center. We hypothesized that weekly follow up would result in better compliance and less toxicity, leading to better outcomes. Methods: Patients with locally advanced esophageal adenocarcinoma referred to our cancer center for potentially curable neoadjuvant therapy were identified. Age, gender, radiation dose, weight loss, hospital admissions, and outcome were compared between patients who had intensive follow up and patients who did not. Wilcoxon Rank Sum Test and Chi-squared test, both exact tests using Monte Carlo estimation, were used to compare weekly follow-up status with continuous and categorical factors, respectively. Kaplan-Meier curves and Log-Rank tests were used for OS analysis, and a multivariable model was fit using Cox Proportional Hazard models. Results: 169 were patients eligible for analysis, including 154 men and median age of 66 years. 108 patients were seen weekly by medical oncology while on treatment. Groups had balanced baseline characteristics except for age; the weekly follow up patients were older (68 vs. 63 years, p=0.007). There was no difference in hospitalization rate (33% vs. 28%) or weight loss (4 kg vs. 4.7 kg) between groups. In multivariate analysis, advanced age and stage were associated with worsened OS. Weekly follow up did not lead to improved survival at 3 years (42% vs. 50%). Conclusions: This study is retrospective in nature, but to our knowledge it is the first of its kind to investigate the impact of intensive follow up during concurrent chemotherapy and radiation. Though we did not find improved outcome in patients who were seen weekly, a potential confounder is the older age of these patients. In addition, at our institution patients have close weekly follow up with radiation oncologists, dieticians and oncology nurses. While we were not able to substantiate our hypothesis that weekly follow up by medical oncology leads to improved outcomes, our preliminary findings merit further study.