Health-related quality of life measure distinguishes between low and high clinical T stages in esophageal cancer

Biniam Kidane; Amir Ali; Joanne Sulman; Rebecca Wong; Jennifer J Knox; Gail E Darling

doi:10.21037/atm.2018.06.03

Health-related quality of life measure distinguishes between low and high clinical T stages in esophageal cancer

Ann Transl Med. 2018 Jul;6(13):270. doi: 10.21037/atm.2018.06.03.

Authors

Biniam Kidane^{1

2}, Amir Ali¹, Joanne Sulman^{2

3}, Rebecca Wong⁴, Jennifer J Knox⁴, Gail E Darling^{2

4

5}

Affiliations

¹ Section of Thoracic Surgery, University of Manitoba, Winnipeg, MB, Canada.
² Division of Thoracic Surgery, University of Toronto, Toronto, ON, Canada.
³ Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada.
⁴ Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada.
⁵ Division of Thoracic Surgery, Toronto General Hospital, Toronto, ON, Canada.

Abstract

Background: Functional Assessment of Cancer Therapy-Esophagus (FACT-E) is a health-related quality of life (HRQOL) instrument validated in patients with esophageal cancer. It is made up of both a general component and an esophageal cancer subscale (ECS). Our objective was to explore the relationship between baseline FACT-E, ECS and clinically determined T-stage in patients with stage II-IV cancer of the gastroesophageal junction or thoracic esophagus.

Methods: Data from four prospective studies in Canadian academic hospitals were combined. These were consecutive and eligible patients treated between 1996 and 2014 with clinical stage II-IV cancer of the gastroesophageal junction or thoracic esophagus. All patients completed pre-treatment FACT-E. Parametric (ANOVA) and non-parametric (Kruskal-Wallis) analyses were performed.

Results: Of the 135 patients that were deemed eligible, the T-stage distribution determined clinically was: 10 (7.4%) T1, 33 (24.4%) T2, 79 (58.5%) T3 and 13 (9.6%) T4. Parametric analysis showed no significant association between FACT-E & T-stage, although there was a trend towards significance (P=0.08). Non-parametric analysis showed a significant association between FACT-E and T-stage (P=0.05). Post-hoc tests identified that the most significant differences in FACT-E scores were between T1 and T3 patients. Both parametric (P=0.002) and non-parametric (P=0.003) analyses showed an association between ECS & T-stage. Post-hoc analyses showed significant differences in ECS scores between T1 and higher T-stages (P<0.01).

Conclusions: Patient-reported HRQOL scores appear to be significantly different in patients with clinical T1 esophageal cancer as compared to those with higher clinical T stages. Since distinguishing T1 from T2/T3 lesions is important in guiding the most appropriate treatment modality and since EUS appears to have difficulties reliably making such T-stage distinctions, FACT-E and ECS scores may be helpful as an adjunct to guide decision-making.

Keywords: Esophageal cancer; cancer staging; quality of life; surgery.