OBJECTIVES: Globally, esophageal cancer (EC) ranks 7th in cancer incidence and 6th in cancer-related mortality. A 5-year survival of 3% for stage IV patients reflects poor prognosis and places significant burden on patient lives. A systematic literature review (SLR) was conducted to characterize the humanistic burden using health-related quality of life (HRQoL) outcomes and health utilities in advanced/metastatic esophageal cancer (EC) patients and evaluate evidence gaps.

METHODS: Electronic databases (Embase, PubMed, and Cochrane library; from inception to August 2021) and conferences (2019-2021) were searched to identify English-language publications reporting the humanistic burden of advanced/metastatic EC. Screening per a pre-specified protocol and data extraction were done independently by 2 reviewers.

RESULTS: Ten eligible studies were identified (3 randomized clinical trials (RCTs), 2 cost-effectiveness and 5 observational studies); reporting data from 4 countries and multinational settings in 2 studies. HRQoL data and health utilities were reported in 10 and 8 studies, respectively. Data on humanistic burden of EC was limited and heterogeneous in design, population, and analytical method. HRQoL was reported from generic (EQ-5D) and cancer-specific (EORTC core and symptom modules) scales; assessed as secondary or exploratory endpoint in most studies. Underreporting of statistical methods made data interpretation challenging.

Despite the limited data, the humanistic burden of EC was evident. Utility values were substantially lower (poorer HRQoL) in advanced compared to early-stage disease and healthy individuals. Across 3 RCTs, patients on immuno-oncology agents typically reported improvement in EQ-5D scores and lower risk of deterioration in EORTC core and symptom-specific scales vs. chemotherapy.

CONCLUSIONS: There was a paucity of data on real-world humanistic burden in EC, and the available evidence was not easy to interpret for patients and clinicians. HRQoL burden despite available treatments is an unmet need that underscores the need for therapies that can alleviate the humanistic impact of EC.