Associations between quality-of-life, symptom burden, and demographic characteristics in long-term esophageal and gastroesophageal junction cancer survivors

Background There is limited data regarding the impact of curative intent esophageal and gastroesophageal junction (EGEJ) therapy on quality-of-life (QOL) and symptom burden in long-term survivors. Further, little is known regarding interactions between patient characteristics (e.g. age, education level) and long-term functioning. Methods EGEJ survivors > 12 months from curative-intent esophagectomy were recruited via institutional tumor registry and in-person surveillance visits. The Dillman mailed survey method was used. QOL and symptoms were measured using the validated EORTC QLQ-C30 and QLQ-OG25 questionnaires. Patient demographics were self-reported while disease characteristics and treatment history were obtained from chart review. Spearman correlation coefficients, Wilcoxon rank-sum test, and Fisher’s exact test were used to assess differences between groups or relationships between variables. Results Twenty-nine percent (n=41) of 140 eligible patients completed questionnaires. Median age was 67 (range 50-81) years. The population was 78% male (n=32) and 95% white (n=39). Seventy-six percent (n=31) of patients were married and 59% (n=24) completed a high school degree or higher. Median time since diagnosis was 7 years (range 2-25). Twenty-two percent had pathologic stage I disease (n=9), 34% stage II (n=14), and 39% stage III (n=16). Most tumors were adenocarcinoma (83%) located in the lower esophagus (61%) followed by GEJ (27%). Seventy-one percent (n=29) received neoadjuvant therapy; 59% (n=24) had a complete pathologic response. Patients using opiates at the time of survey (n=8) reported lower role functioning (median score or MS 66.7 vs. 100.0, p=0.004), higher rates of fatigue (MS 44.4 vs. 22.2, p=0.029), higher pain (MS 41.7 vs. 0.0, p=0.022), lower social functioning (MS 58.3 vs. 100.0, p=0.052), and lower overall global health (MS 62.5 vs. 83.3, p=0.041). There were significant negative correlations between emotional functioning and symptom burden – including dysphagia (r=-0.34, p=0.028) food reflux (r=-0.47, p=0.002), odynophagia (r=-0.37, p=0.017), pain (r=-.41, p=0.008), anxiety (r=-0.54, p=0.0003), and cough (r=-0.36, p=0.021). Compared to patients ≥ 65, younger patients < 65 (n=15) had significantly higher rates of reflux (MS 33.3 vs. 16.7, p=0.019), odynophagia (MS 33.3 vs. 0.0, p=0.045), choking (MS 33.3 vs. 0.0, p=0.005), and cough (MS 33.3 vs. 33.3, p=0.007). Younger patients also had lower emotional functioning (MS 66.7 vs. 95.8, p=0.007) with a trend towards increased anxiety (MS 33.3 vs. 16.7, p=0.060) and worse body image (MS 33.3 vs. 0.0, p=0.072). Lower levels of education (HS or lower, n=17) were associated with higher symptom burden including higher dysphagia (MS 11.1 vs. 0.0, p=0.048), reflux (MS 33.3 vs. 16.7, p=0.039), pain (MS 33.3 vs. 16.7, p=0.005), anxiety (MS 50.0 vs. 16.7, p=0.001) and lower social functioning (MS 66.7 vs. 100.0, p=0.025). Male patients reported higher pain scores (MS 33.3 vs. 0.0, p=0.030) versus female patients. QOL measures were not associated with marital status or income. Conclusions In this cohort of long-term EGEJ survivors, younger patients or those with a lower level of education or on current opiate therapy tended to have higher symptom burden and lower QOL. Additional research is needed to understand the specific mechanisms contributing to these differences, and help design interventions to target EGEJ survivors that are at the highest risk of long-term impairments. Legal entity responsible for the study The authors. Funding Supported by a Cancer Center Support Grant 3 P30 CA006927-47S4. Disclosure C. Denlinger: Advisory / Consultancy: Taiho Oncology, Exelixis, Bristol Myer Squibb, BeiGene, Merck, Zymeworks; Research grant / Funding (institution): Amgen, Agios Pharmaceuticals, Array BioPharma, BeiGene, Genmab, Bristol Myer Squibb, Miracogen, Zymeworks, Sanofi Aventis, MedImmune, Astra Zeneca. All other authors have declared no conflicts of interest.