title: Baseline measure of health-related quality of life (Functional Assessment of Cancer Therapy-Esophagus) is associated with overall survival in patients with esophageal cancer.
abstract: OBJECTIVE
  Functional Assessment of Cancer Therapy-Esophagus is a health-related quality of life instrument validated in patients with esophageal cancer. It is composed of a general component and an esophageal cancer subscale. Our objective was to determine whether the baseline Functional Assessment of Cancer Therapy-Esophagus and esophageal cancer subscale scores are associated with survival in patients with stage II and 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 and III esophageal cancer who received neoadjuvant therapy followed by surgery or chemoradiation/radiation alone. All patients completed baseline Functional Assessment of Cancer Therapy-Esophagus. Functional Assessment of Cancer Therapy-Esophagus and esophageal cancer subscale scores were dichotomized on the basis of 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% of patients (n = 144) had adenocarcinoma. All patients had more than 9 months of follow-up. In patients with stage II and III, 93 deaths were observed. When treated as continuous variables, baseline Functional Assessment of Cancer Therapy-Esophagus and esophageal cancer subscale were associated with survival with hazard ratios of 0.89 (95% confidence interval [CI], 0.81-0.96; P = .005) and 0.68 (95% CI, 0.56-0.82; P < .001), respectively. When dichotomized, they were also associated with survival with a hazard ratio of 0.58 (95% CI, 0.38-0.89; P = .01) and 0.43 (95% CI, 0.28-0.67; P < .001), respectively.
  
  
  CONCLUSIONS
  In patients with stage II and III esophageal cancer being considered for therapy, higher baseline Functional Assessment of Cancer Therapy-Esophagus and esophageal cancer subscale were independently associated with longer survival, even after adjusting for age, stage, histology, and therapy received. Further study is needed, but Functional Assessment of Cancer Therapy-Esophagus may be useful as a prognostic tool to inform patient decision-making and patient selection criteria for studies.
authors.affiliation: Division of Thoracic Surgery, University of Toronto, Toronto, Ontario, Canada; Divison of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
authors.forename: Biniam
authors.initials: B
authors.lastname: Kidane
authors.affiliation: Divison of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Joanne
authors.initials: J
authors.lastname: Sulman
authors.affiliation: Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada.
authors.forename: Wei
authors.initials: W
authors.lastname: Xu
authors.affiliation: Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada.
authors.forename: Qin Quinn
authors.initials: QQ
authors.lastname: Kong
authors.affiliation: Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Wong
authors.affiliation: Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada; Department of Medical Oncology, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Knox
authors.affiliation: Division of Thoracic Surgery, University of Toronto, Toronto, Ontario, Canada; Divison of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada. Electronic address: gail.darling@uhn.on.ca.
authors.forename: Gail E
authors.initials: GE
authors.lastname: Darling
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006305:Health Status Indicators; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D011788:Quality of Life
keywords: esophageal cancer; predictive model; quality of life; survival