Real-world Compliance to Trimodality Therapy and its Effect on Survival in Esophageal Squamous Cell Carcinoma: Insights from a High-burden Region.

Abstract

Trimodality treatment (neoadjuvant chemoradiotherapy followed by surgery) improves survival in esophageal squamous cell carcinoma (ESCC). However, patient compliance remains a challenge, particularly in high-burden areas like North-East India. To evaluate the compliance rate for trimodality treatment. To evaluate the reasons for non-compliance and to estimate the overall survival of the study patients. This retrospective study involved 113 patients with locally advanced, resectable ESCC treated at a tertiary care center from January 2021 to December 2022. Compliance with trimodality therapy was assessed. Reasons for non-compliance were categorized based on medical records and telephone interviews. Overall survival (OS) was analyzed using the Kaplan-Meier method and Cox regression. Compliance was calculated as the percentage of patients completing trimodality treatment. Reasons for non-compliance were identified through electronic medical records and phone interviews and shown in a pie chart. Kaplan-Meier and log-rank tests were used to assess survival, while Cox regression identified related factors. SPSS (version 29) and Excel were used for analysis, with significance set at p < 0.05. Only 48 patients (44.03%) completed the planned trimodality treatment. The main reason for non-compliance (66%) was subjective symptom relief after chemoradiotherapy, possibly due to inadequate counseling. Financial issues, disease progression, poor health, and inoperability were other factors. Patients completing treatment showed significantly better survival (1-year OS 83.3% vs. 50.8%; 3-year OS 54.3% vs. 20.3%; p<0.001). Cox regression revealed that incomplete treatment was associated with a 3.2-times higher risk of death. Other factors such as age, gender, comorbidities, and nodal status did not significantly affect survival. Compliance with trimodality treatment significantly improves survival in ESCC. Improving patient counselling, financial support, and follow-up may help increase compliance and outcomes in high-burden regions.