Long-Term Health-Related Quality of Life in Esophageal Cancer Survivors: A Literature Review

OBJECTIVES: Long-term survival after esophageal cancer has substantially increased in recent years. The quality of survivorship is becoming more relevant to fully capture the remaining unmet need in this population. We aimed to recognize factors related to long-term health-related quality of life (HRQL) in esophageal cancer survivors.

METHODS: We conducted a targeted literature review to identify longitudinal studies assessing the HRQL of esophageal cancer survivors, using the key terms ‘esophageal cancer’, ‘survivors’, ‘HRQL’, and ‘long-term’. Searches were conducted on PubMed (January 2019–December 2023).

RESULTS: The literature search identified 16 relevant studies which assessed HRQL ≥1 year after treatment was completed. Of these studies, six assessed HRQL for ≥10 years and four compared the HRQL of esophageal cancer survivors to the general population. All studies, except one, measured HRQL using EORTC QLQ-C30 and 12 also utilized either EORTC QLQ Oesophago Gastric 25 or EORTC QLQ Oesophageal 18. The majority of studies recruited patients who had undergone curative surgery with or without neoadjuvant/adjuvant treatment. Most common symptoms and comorbidities affecting HRQL were dysphagia and eating difficulties, reflux, dyspnea, fatigue, pain and discomfort, appetite loss, weight loss, and dry mouth. Over half the studies agreed that symptom burden persisted into the long-term. Studies disagreed on whether long-term global HRQL was decreased in esophageal cancer survivors; however, functioning specifically was more likely to be affected. Five studies found that postoperative complications led to impaired HRQL years after surgery. Other vulnerable populations identified were those with more advanced tumor stage, who received postoperative chemotherapy and of a younger age.

CONCLUSIONS: Esophageal cancer survivors often suffer from high symptomatic burden and deterioration in long-term HRQL. Further longitudinal studies are required to understand the specific factors contributing to long-term impairment of HRQL in order to improve treatment strategies and achieve high quality survivorship.