Patients who underwent minimally invasive treatment tended to have better quality-of-life outcomes than those who had a full esophagus removal, though there were risk factors for long-term outcomes that should be considered.
Side effects and long-term issues vary based on the type of treatment used for esophageal cancer, highlighting the importance of patient-provider communication before a care plan is made, according to research presented at the 2023 Gastrointestinal Cancers Symposium, a conference hosted by the American Society of Clinical Oncology.
The study, which included 420 patients who underwent esophageal cancer treatment in Sweden between 2013 and 2020, showed that patients who underwent endoscopic treatment (a minimally invasive procedure) tended to have better health-reported quality of life outcomes than those who underwent a esophagectomy (surgical removal of the esophagus).
“I think that if we could — which is a big challenge — identify patients early with esophageal cancer, we could also offer them less expensive treatment with a better quality-of-life outcome,” explained study author Pernilla Lagergren, of the Karolinska Institute in Sweden and Imperial College London.
Those who underwent esophagectomy also tended to be more likely to experience reflux, which could cause sleep disturbances.
“Taking these two together, patients having reflux and sleep disturbances, they had much worse health-related quality of life, and also reported high burden of symptoms in all aspects that we measured,” Legergren said, noting that some of the most common side effects from esophageal cancer treatment included eating problems, fatigue, anxiety and coughing.
More than a third of patients (36%) experienced high levels of fatigue that tended to get worse over time.
“From previous research, we know that many patients recover back… quality of life. But some patients or subgroups never recover; they even deteriorate over time, and we have that up to 15 years after surgery,” Legergren explained.
The most common risk factors that were associated with increasing fatigue included other comorbidities, advanced tumor stage and anxiety/depression. Legergren also cited previous research that showed older age, being female and the financial stress from treatment were all risk factors for both the increased fatigue and anxiety/depression, reducing overall quality of life.
“Patients who are more optimistic, they have less psychological distress and they also report a better quality of life,” Legergren said. “But we also have to consider the (fear) of cancer recurrence in these patients and I think that information is the key here. Because we have seen nice figures of survival rates from endoscopic treatment of early cancer, with that, we could inform patients in a better way.”
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