Baseline Measure of Health-related Quality of Life (FACT-E) is Associated with Overall Survival in Esophageal Cancer Patients

• Published in: The Journal of thoracic and cardiovascular surgery
• Main Authors: Kidane, Biniam, MD MSc, Sulman, Joanne, MSW, Xu, Wei, PhD, Kong, Qin Quinn, MSc, Wong, Rebecca, MBChB MSc, Knox, Jennifer J., MD MSc, Darling, Gail E., MD
• Format: Journal Article
• Language: English
• Published: 2016
• Subjects: Cardiothoracic Surgery; Functional Assessment of Cancer Therapy-Esophagus; FACT-G; FACT-E; esophageal cancer subscale; EORTC; health-related quality of life; HR; Functional Assessment of Cancer Therapy- General; RSCL; Hazard ratio; American Joint Committee on Cancer; ECS; OE; oesophagus; AJCC; QLQ; HRQOL; Rotterdam Symptom Checklist; quality of life questionnaire; European Organization for Research and Treatment of Cancer
• ISSN: 0022-5223
• DOI: 10.1016/j.jtcvs.2016.01.052

Abstract Objective Functional Assessment of Cancer Therapy-Esophagus (FACT-E) is a health-related quality of life (HRQOL) instrument validated in esophageal cancer patients. It is comprised of a general component (FACT-G) and an esophageal cancer subscale (ECS). Our objective was to determine if baseline FACT-E and ECS is associated with survival in patients with Stage II-III cancer of the gastroesophageal junction or thoracic esophagus. Methods Data from 4 prospective studies in Canadian academic hospitals were combined. These included consecutive patients with stage II-III esophageal cancer who received neoadjuvant therapy followed by surgery or chemoradiation/radiation alone. All patients completed baseline FACT-E. FACT-E and ECS scores were dichotomized based on median scores. Cox regression analyses were performed. Results There were 207 patients treated between 1996 and 2014. Mean age was 61 + 10.6 years. Approximately 69.6% (n=144) had adenocarcinoma. All patients had >9 months of follow-up.In stage II-III patients, 93 deaths were observed. When treated as continuous variables, baseline FACT-E and ECS were associated with survival with hazard ratios (HR) of 0.89 (0.81-0.96, p=0.005) and 0.68 (0.56-0.82, p<0.001), respectively. When dichotomized, they were also associated with survival with HR of 0.58 (0.38-0.89, p=0.01) and 0.43 (0.28-0.67, p<0.001), respectively. Conclusions In patients with stage II-III esophageal cancer being considered for therapy, higher baseline FACT-E and ECS were independently associated with longer survival, even after adjusting for age, stage, histology and therapy received. Further study is needed but FACT-E may be useful as a prognostic tool to inform patient decision-making as well as patient selection criteria for studies.