503. HEALTH-RELATED QUALITY OF LIFE FOLLOWING CURATIVE INTENT TREATMENT FOR ESOPHAGEAL CANCER: IMPACT OF TREATMENT PATHWAY ON PATIENT-REPORTED OUTCOMES IN SURVIVORSHIP

Background Recent improvements in treatment modalities for esophageal cancer have resulted in improved survival outcomes, and optimisation of health-related quality of life (HR-QL) in survivorship is now an increasing focus. This study aimed to compare HR-QL in survivorship following treatment with definitive chemoradiation (dCRT), neoadjuvant chemoradiation and surgery (nCRT), neoadjuvant chemotherapy and surgery (nCT), and surgery only (S). Methods This was a cross-sectional study of patients who underwent oesophageal cancer treatment between 2010 and 2021. A multicomponent questionnaire was distributed to disease-free patients at least one year post completion of treatment. Scores were calculated according to the European Organisation for Research and Treatment of Cancer manual. A mean difference of ten points or more for symptom and function scales was considered clinically significant. One-way ANOVA was performed to detect statistically significant differences between treatment groups. Results Some 125 patients were included. Global HR-QL was similar between treatment groups (mean±SD, dCRT 67.4±20.9, nCRT 71.5±19.6, nCT 80.0±15.0, S 69.0±20.0, P=0.265). Analysis of functional scales found lower emotional functioning (S 71.1±25.5 vs dCRT 87.1±15.6, nCRT 79.6±19.5, nCT 88.9±26.3, P=0.028) and body image scores (S 71.8±29.2 vs dCRT 87.9±22.5, nCRT 83.3±27.8, nCT 91.1±19.8, P=0.056) among patients treated with surgery only. Dysphagia (P=0.034), trouble with coughing (P=0.014) and choking when swallowing (P=0.018) were increased following dCRT as compared with surgical treatment. Following surgical treatment, patients reported more diarrhoea as compared with dCRT (P=0.020), while dCRT was associated with increased constipation (P=0.004). Conclusion Overall HR-QL was similar between groups, but distinct patterns of symptoms were observed in different cohorts. Symptoms related to swallow function were more common in patients treated with dCRT, while patients who underwent surgery exhibited more diarrhoea, possibly reflective of increased dumping syndrome. Interestingly, patients who received surgery upfront reported lower scores for emotional functioning and body image in the long-term after treatment, as compared with other groups. Further research is needed to determine the differential psychological impact of major resectional upper GI surgery among patients presenting with early stage versus locally advanced disease.