Quality Of Life Assessment In Patients With Esophageal Or Cardiac Cancer, A Study Of 421 Cases

Objective: The advances in cancer diagnosis and treatment have allowed patients to have a longer life span than in the past.However, there is evidence that oncologic patients may present with difficulties in their psychological adaptation and a worsening in quality of life (QOL). Usually, the concept of"quality of life"refers to the patients'perception of performance in at least one of four important domains: (1) somatic sensation; (2) physical function, (3) emotional state, and (4) social interaction. The European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 is one of the most widely used quality of life instruments for cancer patients. In this study,we retrospectively investigated the quality of life of patients with esophageal cancer(EC) or cardiac cancer(CC) after operation at different time section from 1996 to 2006 in the Fourth Hospital of Heibei Medical University using EORTC QLQ-C30, analyzed the QOL changing with time, and evaluated the main impact parameters on the QOL of EC and CC.Methods: Randomly selecting 421 cases of EC or CC from January 1996 to December 2006 in the Fourth Hospital of Hebei Medical University. The demographic and medical data were collected using the general information investigation form and QLQ-C30 (3.0).All data were analyzed by SPSS13.0 software package. One-way ANOVO was used to evaluate the QOL at different postoperation periods and the impact of sex and anastomosis. Logistic multiple regression was used to analyze the correlation between the 11 variables: sex,age,incision type,removal range,extent of lymph nodes dissection,operation anastomosis,pathological diagnosis,infiltrating depth,clinical stage,therapeutic method,time after operation, and the QOL of EC or CC patients.Results:1 One-way ANOVA results1.1 There were significant difference in 3 domains including cognition functioning, social functioning and general QOL among 1~2 years postoperation group, 2~5 years postoperation and≥5 years(P<0.05). There were no significant difference in physical functioning, role functioning and emotional functioning (P>0.05).1.2 There were no significant difference in 3 domains including fatigue, pain, nausea and vomiting among 1~2 years postoperation group, 2~5 years postoperation and≥5 years(P>0.05).1.3 There were significant difference in 3 domains including constipation , diarrhea and dyspnoes (P<0.05) among 1~2 years postoperation group, 2~5 years postoperation and≥5 years(P<0.05). No significant difference was seen in sleep, appetite and economy status(P>0.05). Diarrhea and dyspnoea were most seen in 2~5 years postoperation group, while constipation were most seen in≥5 years postoperation group.1.4 Gender impact on QOL: There were significant difference in physical functioning and sleep quality between male patients and female patients, (P<0.05).1.5 Anastomosis impact on QOL: Patients with supra-aortic anastomosis showed better performance than others in general QOL, nausea and vomiting, appetite, and constipation (P<0.05); patients with aorta-cervical anastomosis were significant better in physical functioning, and pain(P<0.05).2 Logistic multiple regression analyzing results on impact parameters:Impact parameters on general QOL was the time after operation; on physical functioning was gender; on cognition functioning was gender,age,lymph nodes dissection extent and time after operation ;on social functioning was gender and pathological stage. Anastomosis,incision type,pathological diagnosis and infiltrating depth influenced nausea and vomiting,pain and fatigue. Gender,incision type,dissection extent,clinical stage and time after operation influenced sleep quality,appetite,constipation,diarrhea,dyspnoea and economy status.Conclusions:1 There were significant difference on QOL in different postoperation periods. Cognition functioning and social functioning were best in 1~2 years postoperation group, while general QOL were best in≥5 years postoperation group.2 Gender influenced QOL : physical functioning in male patients was better than female, but sleep interference was fewer in female.3 Anastomosis influenced QOL : Patients with supra-aortic anastomosis showed better performance in general QOL, nausea and vomiting, appetite, and constipation (P<0.05); patients with aorta-cervical anastomosis were significant better in physical functioning, and pain(P<0.05).4 Gender,age,anastomosis,dissection extent,clinical stage and time after operation etc. influenced all items except cognition functioning,emotional functioning and appetite.Therapeutic methods showed no significant impact on QOL in patients after operation more than 1 year.