LAsting Symptoms after Oesophageal Resectional Surgery (LASORS): multicentre validation cohort study.
Heidi Paine, Swathikan Chidambaram, Asif Johar, Nick Maynard, Pernilla Lagergren, Ewen A Griffiths, Paul Behrens, Pritam Singh, Nima Abbassi-Ghadi, Shaun R Preston, Ravinder S Vohra, James Gossage, Tim Underwood, Nick Dai, J Robert O'Neill, Sherif Awad, Borzoueh Mohammadi, Khaled Dawas, Yassar Qureshi, Bilal Alkhaffaf, Rhys Jones, George B Hanna, Sheraz R Markar
Author Information
Heidi Paine: Nuffield Department of Surgery, University of Oxford, Oxford, UK.
Swathikan Chidambaram: Academic Surgical Unit, Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, UK. ORCID
Asif Johar: Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Nick Maynard: Department of Surgery, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK.
Pernilla Lagergren: Academic Surgical Unit, Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, UK. ORCID
Ewen A Griffiths: Department of Upper GI Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK. ORCID
Paul Behrens: Edinburgh Law School, University of Edinburgh, Edinburgh, UK.
Pritam Singh: Department of Surgery, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK. ORCID
Nima Abbassi-Ghadi: Department of Surgery, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK.
Shaun R Preston: Department of Surgery, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK.
Ravinder S Vohra: Department of Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK.
James Gossage: Department of Surgery, St Thomas' Hospital, London, UK.
Tim Underwood: Division of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
Nick Dai: Cambridge Oesophagogastric Centre, Cambridge University Hospitals, Cambridge, UK. ORCID
J Robert O'Neill: Cambridge Oesophagogastric Centre, Cambridge University Hospitals, Cambridge, UK.
Sherif Awad: Department of Upper GI Surgery, Royal Derby Hospital, University Hospitals of Derby & Burton NHS Foundation Trust, Derby, UK.
Borzoueh Mohammadi: Department of Surgery, University College London Hospitals NHS Foundation Trust, London, UK.
Khaled Dawas: Department of Surgery, University College London Hospitals NHS Foundation Trust, London, UK.
Yassar Qureshi: Department of Surgery, University College London Hospitals NHS Foundation Trust, London, UK.
Bilal Alkhaffaf: Department of Oesophago-Gastric & Bariatric Surgery, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester, UK. ORCID
Rhys Jones: Department of Surgery, James Cook University Hospital, Middlesborough, UK.
George B Hanna: Academic Surgical Unit, Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, UK.
Sheraz R Markar: Nuffield Department of Surgery, University of Oxford, Oxford, UK. ORCID
BACKGROUND: Long-term symptom burden and health-related quality-of-life outcomes after curative oesophageal Cancer treatment are poorly understood. Existing tools are cumbersome and do not address the post-treatment population specifically. The aim of this study was to validate the six-symptom LASORS tool for identifying patients after curative oesophageal Cancer treatment with poor health-related quality of life and to assess its clinical utility. METHODS: Between 2015 and 2019, patients from 15 UK centres who underwent curative-intent oesophageal Cancer treatment, and were disease-free at least 1 year after surgery, were invited to participate in the study and complete LASORS and European Organisation for Research and Treatment of Cancer QLQ-C30 and QLQ-OG25 questionnaires. Receiver operating characteristic curve analysis was used to examine the accuracy of the LASORS tool for identifying patients with poor health-related quality of life. RESULTS: A total of 263 patients completed the questionnaire. Four of the six LASORS symptoms were associated with poor health-related quality of life: reduced energy (OR 2.13 (95% c.i. 1.45 to 3.13)); low mood (OR 1.86 (95% c.i. 1.20 to 2.88)); diarrhoea more than three times a day unrelated to eating (OR 1.48 (95% c.i. 1.06 to 2.07)); and bloating or cramping after eating (OR 1.35 (95% c.i. 1.03 to 1.77)). The LASORS tool showed good diagnostic accuracy with an area under the receiver operating characteristic curve of 0.858 for identifying patients with poor health-related quality of life. CONCLUSION: The six-symptom LASORS tool generated a reliable model for identification of patients with poor health-related quality of life after curative treatment for oesophageal Cancer. This is the first tool of its kind to be prospectively validated in the post-esophagectomy population. Clinical utility lies in identification of patients at risk of poor health-related quality of life, ease of use of the tool, and in planning survivorship services.
References
CA Cancer J Clin. 2024 May-Jun;74(3):229-263
[PMID: 38572751]
