Weight Loss, Symptom Burden in Esophageal Cancer Negatively Associated With QOL

Survivors of esophageal cancer who experience a larger loss of body mass between 6 months prior to diagnosis and the time of diagnosis and who have greater symptom burden have worse quality of life (QOL). These study results were published in the European Journal of Oncology Nursing.

Survivors of esophageal cancer frequently experience weight loss. Additionally, they often experience disease-related and/or treatment-related symptoms and deteriorating QOL. Here, researchers aimed to evaluate the relationships across weight loss, symptom distress, and postoperative QOL in patients with esophageal cancer receiving chemotherapy to better elucidate what impacts QOL.

This retrospective observational study with 101 survivors of esophageal cancer at Shandong Cancer Hospital and Institute in Shandong, China, collected data on percentage of total body mass lost, QOL via the Chinese version of the European Organization for Research and Treatment of Cancer-Quality of Life Question-Core-30 (EORTC-QLQ-C30) and Chinese version of the EORTC-QLQ Eosophageal Cancer Module-18 (EORTC-QLQ-OES-18), and symptom distress via the Chinese version of the MD Anderson Symptom Inventory Gastrointestinal Cancer Module (MDASI-GI-C). Average age of the patients was 61.9 years (SD, 8.59 years), and 89.1% were male.

Weight loss was the greatest between diagnosis and 1 month after surgery. It appeared to slow down after this period. At stage 1 (between 6 months prior to diagnosis and diagnosis), weight loss was 1.00%±2.48%; at stage 2 (between diagnosis and 1 month after surgery), 4.69%±4.73; at stage 3 (between 1 month after surgery and before chemotherapy), 1.66%±5.37%; and at stage 4 (between before chemotherapy and the time of research), 2.67%±5.10%.

On the EORTC-QLQ-C30, global overall health status/overall QOL score was 66.24 (SD, 18.65). Social function ranked the worst among the 5 functions (70.99±18.20), with financial difficulties (35.28±25.75), fatigue (32.6±15.17), and loss of appetite (31.66±28.05) ranking as the most severe symptoms.

On the EORTC-QLQ-EOS18, symptoms with scores indicating worse health included eating difficulties (28.47±18.29), dry mouth (27.69±27.11), choking (26.03±25.20), coughing (24.73±30.43), and reflux (23.10±18.99).

On the MDASI-GI-C, mean symptom severity score was 3.30±1.74, with the highest scores for fatigue (4.19±2.32), dysphagia (4.04±2.89), and poor appetite (4.01±2.63). The mean symptom interference score was 2.76±1.90, with interference with work being the most reported (3.49±2.66).

Weight loss and symptom distress were negatively associated with patients’ QOL (P <.05 and P <.01, respectively). Both weight loss between 6 months prior to diagnosis and time of diagnosis (P <.05) and symptom interference (P <.01) were orthogonal predictors of QOL.

These results emphasize the importance of clinicians focusing on patients’ weight and management of symptom burden as a means of improving QOL.

“The present study represents the dynamic changes in weight in patients with oesophageal cancer and an overview of symptom distress and QOL in postsurgical patients during chemotherapy. It underlines the correlation between patients’ weight loss, symptom distress, and QOL,” the authors concluded. “Weight loss in patients with oesophageal cancer is common; weight management and early intervention targeting relief from financial difficulties, fatigue, loss of appetite, dysphagia, and symptom distress may be helpful.”

Reference

Jia S, Chen Y, Cui J, Wang T, Lin CC. Relationship of weight loss to quality of life and symptom distress among postsurgical survivors of oesophageal cancer who received chemotherapy [published online ahead of print, 2023 Jun 15]. Eur J Oncol Nurs. 2023;66:102370. doi:10.1016/j.ejon.2023.102370