OBJECTIVES: GI cancers account for over 25% of global cancer cases. Impact of cancer stage on patient-reported outcomes is poorly understood. This research aimed to understand symptom burden and HRQoL impact by stage for colorectal, esophageal, and pancreatic cancer.

METHODS: Literature searches were conducted using an AI-assisted platform to identify relevant articles published in the last five (2017-2022) or ten years (2012-2022) where articles were limited. Conference abstracts were searched for the last two years (2020-2022). Geographic scope was the US, Canada, and Europe.

RESULTS: Compared with early-stage colorectal cancer, patients with advanced stage disease reported significantly poorer physical SF-12 scores in two studies (both p<0.05). Mental SF-12 scores were significantly poorer in advanced stage disease (p<0.01) in one study while the second study did not find a meaningful association. Patients with stage III disease had significantly more symptoms (SCL-17, p=0.001) and worse HRQoL (FACT-C, p=0.004) compared with stage II disease. Depression was more prevalent in patients with metastasis vs no metastasis (p<0.015).

Considering a minimally important difference of 0.07 for EQ-5D utilities, patients with stage IV esophageal cancer had poorer HRQoL compared with stage II/III (0.72±0.18 vs 0.82±0.13, respectively). HRQoL stratified by T-stage was also significantly poorer at higher T-stages (FACT-ECS, 58.7±9.1 vs 44.5±15.4, T1 vs T4; p<0.01).

Patients with stage III and IV pancreatic cancer had a significantly increased risk of poorer physical SF-12 scores compared with stage I (1.80-fold and 2.32-fold, respectively; p for trend <0.001). There was no significant association with mental SF-12 scores.

CONCLUSIONS: Stage or spread of disease has a significant role in symptom burden as reflected by the worse physical HRQoL and symptomology reported in advanced GI cancers. This supports the importance of detecting cancer at earlier stages to attenuate symptom burden and to minimize the negative impact on HRQoL and functional status.