The effect of definitive chemoradiotherapy on quality of life in patients with esophageal cancer: Analysis of the Dutch population-based POCOP registry.
Authors: Veen Linde , Pape Marieke , Hulshof Maarten C.C.M. , Jeene Paul M. , Slingerland Marije , Neelis Karen J. , Loosveld Olaf , Rozema Tom , Sprangers Mirjam A.G. , Verhoeven Rob , Van Laarhoven Hanneke W.M. 
Published: January 2023

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Background: Definitive chemoradiotherapy (dCRT) can achieve durable local control and even curation in patients with locally advanced irresectable esophageal carcinoma. However, due to side-effects of this treatment, survival benefit may come at the cost of quality of life (QoL). This study aims to report prospectively collected patient-reported outcome measures (PROMs) after dCRT. Methods: Patients with squamous cell carcinoma or adenocarcinoma of the esophagus receiving dCRT and participating in the Prospective Observational Cohort Study of Oesophageal-gastric cancer Patients (POCOP) were eligible. dCRT was defined as radiotherapy consisting of at least 50.4Gy/28F with concomitant weekly carboplatin and paclitaxel. PROMs were extracted from the POCOP database, which uses validated questionnaires EORTC QLQ-C30 and OG25. Questionnaires were collected at baseline, at three months (3M), at six months (6M) and every three months thereafter for a total follow-up of 2 years. Clinical data were derived from the nationwide Netherlands Cancer Registry (NCR). PROMs were compared to baseline values using mixed effect models. Results: In total, 153 patients were included. The median age was 70 years and patients were predominantly male (73.2%). 51% of patients had esophageal adenocarcinoma and the majority had a performance status score 0 (39.9%) or 1 (46.4%). The number of returned questionnaires ranged from 96 at baseline to 106 at 3M and 36 at 2 years. Global Health Status at baseline was 69.9 (SD 17.6) and declined at 3M, although not significantly. At later time points, scores showed a trend towards improvement compared to baseline. Patients reported significantly lower physical (71.5, SD 19.4), role (67.8, SD 31.0) and social functioning (72.4, SD 29.1) at 3M compared to baseline (82.7, 79.7 and 81.5 respectively, all p<0.01). For social and role functioning, scores returned to baseline at 6M and subsequent time points, but physical functioning scores remained significantly lower compared to baseline. Patients reported more fatigue at 3M (42.0, SD 27.1) compared to baseline (28.9, p<0.001) but recovered at 6M. Emotional functioning significantly improved from baseline (73.5, SD 19.7) to 3M (80.1, SD 21.7, p=0.002) and subsequent time points. Patients reported an improvement of several disease-specific symptoms such as eating restrictions (-20.3, p<0.001), weight loss (-12.7, p<0.01), odynophagia (-21.9, p<0.001) and dysphagia (-17.9, p<0.001) at all time points, but most pronounced at 18 months after baseline. Conclusions: Prospectively collected PROMs showed that fatigue, social and role functioning temporarily deteriorated after dCRT. Physical functioning was decreased after three months and did not recover to baseline. Emotional functioning significantly improved and the burden of disease-specific symptoms decreased.