Symptoms, problems and quality of life in patients newly diagnosed with oesophageal and gastric cancer - a comparative study of treatment strategy

• Published in: BMC cancer Vol. 22; no. 1; p. 434
• Main Authors: Dalhammar, Karin, Kristensson, Jimmie, Falkenback, Dan, Rasmussen, Birgit H, Malmström, Marlene
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 21-04-2022; BioMed Central; BMC
• Subjects: Cancer; Cancer and Oncology; Cancer och onkologi; Cancer therapies; Care and treatment; Chemotherapy; Clinical Medicine; Comparative analysis; Complications and side effects; Cross-Sectional Studies; Disease; Dysphagia; Dyspnea; Esophageal cancer; Esophageal Neoplasms - surgery; Esophagus; Gastric cancer; Health aspects; Humans; Klinisk medicin; Likert scale; Medical and Health Sciences; Medical prognosis; Medical records; Medicin och hälsovetenskap; Methods; Oesophageal cancer; Oncology, Experimental; Palliative care; Palliative treatment; Patients; Problems; Quality of life; Quality of Life - psychology; Questionnaires; Radiation therapy; Respiration; Sleep disorders; Stomach cancer; Stomach Neoplasms - therapy; Surveys and Questionnaires; Symptom management; Symptoms; Sweden; Palliative care; Oesophageal cancer; Problems; Quality-of-life; Gastric cancer; Symptoms
• ISSN: 1471-2407; 1471-2407
• DOI: 10.1186/s12885-022-09536-x

Patients with oesophageal and gastric cancer have a low likelihood of being cured and suffer from a broad spectrum of symptoms and problems that negatively affect their quality-of-life (QOL). Although the majority (67-75%) of patients at the time of diagnosis suffer from an incurable disease, research has primarily focused on the pre- and postoperative phase among patients treated with curative intent, with little attention to symptoms and problems in the diagnostic phase, especially in those who cannot be offered a cure.
In this cross-sectional study 158 patients newly diagnosed with oesophageal and gastric cancer visiting the surgical outpatient department for a preplanned care visit were included consecutively during 2018-2020. The validated instruments QLQ-C30 and QLQ-OG25, developed by the European Organization for Research and Treatment of Cancer (EORTC), and selected items from the Integrated Patient Outcome Scale (IPOS) were used to assess QOL, symptoms and problems. Differences between patients with a curative and a palliative treatment strategy were analysed using t-test and Mann-Whitney U test. The QLQ-C30 and QLQ-OG25 scores were compared to published reference data on the general Swedish population.
Among all, the QOL was markedly lower, compared with general Swedish population (mean ± SD, 55.9 ± 24.7 vs 76.4 ± 22.8, p < 0.001). Compared to general population, the patients had significant impairment in all QOL aspects, particularly for role and emotional functioning and for symptoms such as eating-related problems, fatigue, insomnia and dyspnea. Majority of patients also reported severe anxiety among family and friends. Among patients with oesophageal cancer those with a palliative treatment strategy, compared with curative strategy, reported significantly lower QOL (mean ± SD, 50.8 ± 28.6 vs 62.0 ± 22.9 p = 0.030), physical (65.5 ± 22.6 vs 83.9 ± 16.5, p < 0.001) and role functioning (55.7 ± 36.6 vs 73.9 ± 33.3, p = 0.012), and a higher burden of several symptoms and problems. No significant differences between treatment groups were shown among patients with gastric cancer.
Patients newly diagnosed with oesophageal and gastric cancer, and especially those with incurable oesophageal cancer, have a severely affected QOL and several burdensome symptoms and problems. To better address patients' needs, it seems important to integrate a palliative approach into oesophageal and gastric cancer care.