OBJECTIVES: Patients with esophageal cancer (EC), the eighth most diagnosed cancer worldwide, face poor health-related quality of life (HRQoL) due to multiple factors related to disease progression and treatment side-effects. The aim of our systematic literature review was to evaluate health-related quality of life (HRQoL) in this vulnerable patient group in the last ten years.

METHODS: A systematic literature review was conducted to identify studies published between 2013 to May 2023 that evaluated HRQoL in patients with unresectable, locally advanced, or advanced/metastatic esophageal cancer in accordance with disease severity and treatment type. Key biomedical databases such as Embase and Medline were evaluated, supplemented by handsearching, to identify the evidence. Screening and data extraction were performed by two independent reviewers with any conflicts resolved by a third reviewer.

RESULTS: Nine eligible studies reporting HRQoL data were identified (5 RCTs, 4 observational studies). HRQoL was reported in accordance with disease progression and treatment using the following instruments: Quality of Life Questionnaire Core 30 items (QLQ-C30), Quality of Life Questionnaire Esophageal Cancer Module 18 items (QLQ-OES18), Karnofsky Performance Scale (KPS), EuroQoL Five-Dimensions Five-Levels and Visual Analogue Scale (EQ-5D-5L & VAS), and the Linear Analog Self-Assessment fatigue score (LASA). All observational studies (prospective and retrospective) highlighted lower HRQoL in patients with more severe EC (i.e. metastatic) relative to less severe forms of EC (i.e. local advanced). Some RCTs suggest that certain immunotherapies (i.e. tislelizumab, camrelizum, or nivolumab) were associated with higher HRQoL compared to chemotherapies.

CONCLUSIONS: Our findings suggest that some novel immunotherapy treatments may have a positive impact on the HRQoL of patients with advanced or metastatic EC underlying the evolving humanistic burden of this commonly diagnosed and deadly cancer.