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Measurement of and research on quality of life (QOL) have become increasingly important in the field of oncology, especially in esophageal oncology. In recent decades, survival rates after treatment of esophageal cancer, whether through endoluminal treatment or esophagectomy in a multimodal setting, have markedly improved , resulting in an increased awareness of outcome measures beyond more than only survival. However, a substantial group of patients remains incurable, and particularly in these cases, the assessment of QOL becomes essential when considering various palliative therapy options.
Moreover, in the modern era of medicine, patients have evolved into more conscious consumers of healthcare. They often seek active participation in medical decision-making, weighing the advantages and disadvantages of available treatment options themselves. Consequently, QOL data has become a crucial element in supporting the medical decision-making process. In this context, it is evident that the patient’s perspective holds the utmost importance in assessing QOL, surpassing the perceptions of spouses, family, friends, or healthcare professionals. Therefore, Health-Related QOL (HRQOL) questionnaires must be answered by the patients, and many HRQOL instruments are self-administered.
HRQOL assessment evaluates how the patient’s health state affects their QOL. While symptoms and treatments may adversely impact QOL, HRQOL extends beyond a mere list of symptoms associated with the disease or the treatment. It comprehensively assesses various domains, including physical functioning, social functioning, emotional well-being, and functional abilities. For instance, dysphagia may be just one symptom of esophageal cancer, but it has a significant impact on QOL, beyond the physical challenges of swallowing or the potential weight loss. Since sharing meal with family or friends is a social event, dysphagia can lead to withdrawal from those social situations, causing isolation. As a consequence, feelings of sadness or even depression, which may be reflected in HRQOL evaluations, may arise, regardless of the cancer prognosis. As a result, decision-making in oncology is complex and should encompass survival as well as the impact of the natural disease course or the treatment effect on QOL.
This chapter focuses on the assessment of HRQOL in patients with esophageal cancer following both curative and palliative therapy, shedding light on the evolution of QOL after therapy and its interpretation.
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