Esophageal cancer is associated with substantial symptom burden and long-term functional impairment, even among patients treated with curative intent. In addition to survival outcomes, health-related quality of life (HRQoL) has therefore become an essential endpoint in esophageal cancer research. While prior studies have described symptom clusters or HRQoL at individual time points, less is known about how HRQoL evolves longitudinally and whether distinct recovery patterns can be identified at the patient level.
Using longitudinal patient-reported outcome data from a nationwide prospective cohort in the Netherlands, investigators aimed to identify cross-sectional and longitudinal HRQoL profiles among patients with esophageal cancer treated with chemoradiotherapy (CRT), with or without surgery, and to examine associations with demographic and clinical characteristics. The results were published in the Journal of Cancer Survivorship (Springer Nature) on 19 January 2026.
Title: Longitudinal health-related quality of life profiles in esophageal cancer: insights from a nationwide prospective observational cohort study
Authors: Esther Deuning-Smit, Julien A. M. Vos, Ehsan Motazedi, Ellen Engelhardt, Shosha H. M. Peersman, Cecile V. Baartman, Annemarie M. J. Braamse, Monique Borremans-Simons, Merlijn Hutteman, Ewout A. Kouwenhoven, Sjoerd M. Lagarde, Gérard A. P. Nieuwenhuijzen, Jelle P. Ruurda, Marije Slingerland, Fabiola Müller, Hanneke van Laarhoven, Pieter Coenen
Methods
This study analyzed longitudinal data from POCOP, a nationwide population-based observational cohort including patient-reported outcomes. Clinical characteristics were obtained through linkage with the Netherlands Cancer Registry. Patients were eligible if they were diagnosed with potentially curable esophageal cancer (cT1–4a N0–3 M0), received chemoradiotherapy with or without surgery, consented to registry linkage, and completed at least one questionnaire.
HRQoL was assessed at baseline (pre-treatment), 6 months, and 12 months after completion of CRT using validated instruments: the EORTC QLQ-C30, EORTC QLQ-OG25, and the Hospital Anxiety and Depression Scale (HADS). Latent Profile Analysis (LPA) was used to identify cross-sectional HRQoL profiles at each time point, and Latent Transition Analysis (LTA) was applied to describe transitions between profiles over time. Associations between longitudinal profiles and demographic or clinical variables were evaluated using inverse probability weighted multinomial regression analyses.
You can read about GI Radiotherapy: What You Need to Know for 2025 on OncoDaily.
Results
A total of 605 patients were included in the final analysis (mean age 66.6 years; 82% male), of whom 73% underwent surgery in addition to CRT. At each assessed time point, cross-sectional analyses identified two HRQoL profiles: a relatively high HRQoL profile, comprising approximately 78–84% of patients, and a low HRQoL profile, comprising 16–22%.
Both profiles demonstrated impairments compared with general population reference values, particularly for esophageal-specific symptoms captured by the QLQ-OG25, such as dysphagia and eating difficulties. Patients in the low HRQoL profile also reported worse outcomes across general functioning, fatigue, anxiety, and depression domains.
Longitudinal analyses initially identified eight possible transition patterns, which were subsequently consolidated into five clinically interpretable HRQoL trajectories: stable-high (65%), stable-low (5%), improving (10%), deteriorating (14%), and fluctuating (6%). After 12 months, no statistically significant impairments were observed across most HRQoL domains among patients in the stable-high and improving trajectories, whereas persistent impairments were observed in the stable-low and deteriorating trajectories.
Female sex was associated with higher odds of belonging to the stable-low HRQoL trajectory, lower body mass index was associated with higher odds of a deteriorating trajectory, and undergoing surgery was associated with higher odds of a fluctuating HRQoL trajectory.
Conclusion
In this nationwide prospective cohort, most patients with esophageal cancer treated with curative intent experienced relatively high or improving HRQoL during the first year after treatment. However, a subset of patients followed trajectories characterized by persistent or worsening HRQoL. Associations with sex, body mass index, and surgical treatment suggest that demographic and clinical characteristics may help identify patients at increased risk of unfavorable HRQoL trajectories.
These findings support the value of longitudinal HRQoL assessment in esophageal cancer survivorship and provide a framework for further research into targeted follow-up and supportive care strategies.
Full article is available in Journal of Cancer Survivorship (Springer Nature).