Impact of chemotherapy on quality of life in patients with metastatic esophagogastric cancer

BACKGROUND: Health-related quality of life (HRQoL) is a key issue in patients with metastatic esophagogastric cancer, a disease associated with survival times rarely exceeding 10 months. The objective of the current review was to evaluate the effects of chemotherapy on the HRQoL of patients with metastatic or locally advanced, inoperable esophagogastric cancer. METHODS: A systematic MEDLINE search was performed to address a predefined question list: Does chemotherapy improve or maintain HRQoL? Do available data favor a particular chemotherapy? What relation exists between HRQoL and the efficacy and tolerability of therapy? RESULTS: The majority of studies, including large randomized studies, indicated no significant improvements in mean HRQoL scores versus baseline after chemotherapy. However, scores were maintained and symptomatic relief or improved performance status was observed in many patients. HRQoL was maintained in approximately 50% of patients for up to 6 months but deteriorated in the remaining patients. In randomized phase 3 trials, only cisplatin/fluorouracil plus either docetaxel or epirubicin were found to provide superior HRQoL versus comparators. Between-regimen differences in HRQoL scores appeared to correspond to differences in the efficacy rather than the toxicity of treatment regimens. CONCLUSIONS: Chemotherapy maintained HRQoL in a substantial proportion of patients with advanced esophagogastric cancer. This effect appeared to correspond to the efficacy of the treatment.