Esophageal cancer: symptom severity at the end of life

Background: Esophageal cancer (EC) is often diagnosed at an incurable stage where treatment focuses on palliation and quality of life. The objectives of this study were to analyze the symptom trajectory and severity in patients with late-stage EC 6 months before death such that we could finetune palliation treatments at end of life. Methods: We conducted a retrospective, descriptive cohort study to assess symptom scores in EC patients at end of life from January 2009 to September 2016. Symptom scores were derived from Edmonton Symptom Assessment System (ESAS) scores that are collected during outpatient clinic visits at regional cancer centres across Ontario. These scores are stored in Cancer Care Ontario's symptom management reporting database. Our primary outcome was reporting of a moderate-to-severe symptom score for any symptom in the 6 months before death. Results: A total of 4074 patients were included and of these, 2668 (65%) patients completed 1 or more ESAS assessments in the 6 months before death. The most frequently reported moderate-to-severe symptoms were tiredness (84%), poor well-being (81%) and lack of appetite (79%), and a higher proportion of patients began reporting these symptoms and their progression as they approached the end of life. Furthermore, symptom profiles did not vary on the basis of the palliative therapies administered. Finally, multivariate analysis determined specific covariates associated with a higher likelihood of reporting symptoms as moderate to severe, including age over 60 years, female sex, urban residence, immigrant status, being 3-4 months from death and having a high number of comorbidities. In patients with EC within the last 6 months of life, temporal proximity to death was the most important predictor of poor control of symptoms, with a very high proportion of patients reporting a high symptom burden. Multidisciplinary teams can utilize symptom screening scores to identify the appropriate services and therapies to better support patients with EC.