Health-related quality of life in esophageal cancer: a state-of-the-art review of patient-reported outcomes and an evidence and gap map

Abstract

Esophageal cancer represents a substantial global health challenge, marked by poor prognosis, even after curative treatment. Health-related quality of life is crucial for evaluating the treatment efficacy and long-term outcomes in patients with esophageal cancer. This state-of-the-art review and evidence gap map sought to identify existing research on the impact of interventions on health-related quality of life in adults with esophageal cancer, providing a comprehensive overview of various health-related quality of life aspects following diagnosis and treatment. This review entailed a systematic literature search, data extraction, and analysis, with the findings visualized in an evidence and gap map. The review synthesized key insights from the literature, focusing on clinical context, treatment, health-related quality of life outcomes, and interventions to enhance health-related quality of life. The evidence and gap map revealed that most studies concentrated on surgical interventions, chemotherapy/chemoradiotherapy, supportive care, and lifestyle interventions, primarily evaluating the overall quality of life, symptom burden, and emotional and psychological health. Several areas remain unexplored, including cognitive and existential well-being, social functioning, and the impact of specific interventions such as immunotherapy. This review underscores the need for high-quality longitudinal studies assessing long-term health-related quality of life, the inclusion of health-related quality of life as a primary or key secondary endpoint in future trials, and improved methodological quality of systematic reviews. Addressing these gaps will contribute to a more patient-centered, evidence-based approach to esophageal cancer care.