title: Co-morbidity after oesophageal cancer surgery and recovery of health-related quality of life.
abstract: BACKGROUND
  Although health-related quality of life (HRQoL) recovers after surgery for oesophageal cancer in most long-term survivors, one in seven patients experiences a deterioration in HRQoL for reasons yet unknown. The aim of this study was to assess whether co-morbidities diagnosed after surgery influence recovery of HRQoL.
  
  
  METHODS
  Patients who underwent surgery for cancer of the oesophagus or gastro-oesophageal junction in Sweden between 2001 and 2005 were included. HRQoL was assessed by means of the European Organization for Research and Treatment of Cancer QLQ-C30 and QLQ-OES18 questionnaires. Repeated-measures ANOVA was used to assess mean differences in HRQoL scores between three co-morbidity status groups (healthy, stable and increased) over time. Probabilities of deterioration in HRQoL were calculated based on marginal probabilities from logistic regression models.
  
  
  RESULTS
  At 5 years' follow-up, 153 (24·8 per cent) of 616 patients were alive and 137 responded to at least two of three questionnaires. The healthy and increased co-morbidity groups showed deterioration in almost all aspects of HRQoL at 6 months after surgery compared with baseline. The increased co-morbidity group also deteriorated in several aspects from 3 to 5 years after surgery. Patients with an increase in co-morbidity did not have a significantly increased probability of deterioration in HRQoL over time compared with healthy or stable patients, except with respect to cognitive function, loss of appetite, choking and coughing.
  
  
  CONCLUSIONS
  Patients with an increase in co-morbidities after oesophagectomy experience long-term deterioration in HRQoL.
authors.affiliation: Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden. lovisa.backemar@ki.se.
authors.forename: L
authors.initials: L
authors.lastname: Backemar
authors.affiliation: Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Wikman
authors.affiliation: Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.|Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden.
authors.forename: T
authors.initials: T
authors.lastname: Djärv
authors.affiliation: Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Johar
authors.affiliation: Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.
authors.forename: P
authors.initials: P
authors.lastname: Lagergren
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery*; D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000601:surgery; D015897:Comorbidity; D004938:Esophageal Neoplasms / Q000401:mortality / Q000601:surgery*; D016629:Esophagectomy / Q000401:mortality; D004943:Esophagogastric Junction / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D013548:Sweden / Q000453:epidemiology