Key Points

• Quality of Life is a multidimensional construct Incorporating three broad domains—physical, psychological, and social functioning—that are affected by a patient’s disease and treatment.
• Various validated generic and esophageal cancer-specific questionnaires exist to describe patients’ quality of life.
• Patient perception of health-related quality of life (HRQOL) is the outcome of interest, not that of the health care professional, family or caregiver.
• HRQOL is more than a list of symptoms, and although symptoms of the disease or treatment may affect HRQOL, other factor contribute and may be even more important.
• Most disease-free patients after esophageal resection show return to baseline quality-of-life levels.
• Gastric tube reconstruction gives superior quality of life compared with other reconstructive techniques.
• Palliation for incurable esophageal cancer with best long-term results with respect to quality-of-life outcome is best achieved by single-dose brachytherapy.

Measurement and research on quality of life (QOL) is becoming increasingly important in the field of oncology, in particular in esophageal oncology. Indeed, improved survival after specific therapies (endoluminal treatment, esophagectomy-based multimodal tratment) on one hand has increased awereness for other measurement than only survival. On the other hand, many patients still cannot be cured and in this particular group of patients, quality of life has to be weighted against the different palliative therapy options.

Furthermore, patients have become more conscious consumers of health care. They often want to participate in medical decision making by weighing themselves the advantages and disadvantages of the available treatment options. Thus, QOL data have become important in the support of the medical decision-making process. Obviously, it is the patient’s perspective that is most important in assessing QOL, not the perception of the spouse, family, friend or health care professional. 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. Although symptoms may adversely impact QOL, HRQOL is not just a list of symptoms (either of the disease of its treatment) but also evaluates various domains including physical aspects of function, social functioning, emotional well-being and functional abilities. Indeed, dysphagia is just one symptom of esophageal cancer, it has a significant impact on QOL, not just because of the physical problem of swallowing or the weight loss that may result. As sharing meal with family or friends is a social event, dysphagia can lead to withdrawal from those social situations and isolation. Sadness or even depression, that will be translated in HRQOL evaluations, may result, and this irrespectively of the cancer prognosis.

As a result, decision making in oncology is complex and should include impact of disease/treatment on quality of life.

This chapter focuses on the assessment of HRQOL in patients with esophageal cancer after both curative and palliative therapy.