Impact of palliative therapies in metastatic esophageal cancer patients not receiving chemotherapy

Abstract

BACKGROUND Palliative therapy has been associated with improved overall survival (OS) in several tumor types. Not all patients with metastatic esophageal cancer receive palliative chemotherapy, and the roles of other palliative therapies in these patients are limited. AIM To investigate the impact of other palliative therapies in patients with metastatic esophageal cancer not receiving chemotherapy. METHODS The National Cancer Database was used to identify patients between 2004-2015. Patients with M1 disease who declined chemotherapy and had known palliative therapy status [palliative therapies were defined as surgery, radiotherapy (RT), pain management, or any combination thereof] were included. Cases with unknown chemotherapy, RT, or nonprimary surgery status were excluded. Kaplan-Meier estimates of OS were calculated. Cox proportional hazards regression models were employed to examine factors influencing survival. RESULTS Among 140234 esophageal cancer cases, we identified 1493 patients who did not receive chemotherapy and had complete data. Median age was 70 years, most (66.3%) had a Charlson Comorbidity Index (CCI) of 0, and 37.1% were treated at an academic center. The majority (72.7%) did not receive other palliative therapies. On both univariate and multivariable analyses, there was no difference in OS between those receiving other palliative therapy (median 2.83 mo, 95%CI: 2.53-3.12) vs no palliative therapy (2.37 no, 95%CI: 2.2-2.56; multivariable P = 0.290). On univariate, but not multivariable analysis, treatment at an academic center was predictive of improved OS [Hazard ratio (HR) 0.90, 95%CI: 0.80-1.00; P = 0.047]. On multivariable analysis, female sex (HR 0.81, 95%CI: 0.71-0.92) and non-black, other race compared to white race (HR 0.72, 95%CI: 0.56-0.93) were associated with reduced mortality, while South geographic region relative to West region (HR 1.23, 95%CI: 1.04-1.46) and CCI of 1 relative to CCI of 0 (HR 1.17, 95%CI: 1.03-1.32) were associated with increased mortality. Higher histologic grade and T-stage were also associated with worse OS ( P < 0.05). CONCLUSION Palliative therapies other than chemotherapy conferred a numerically higher, but not statistically significant difference in OS among patients with metastatic esophageal cancer not receiving chemotherapy. Quality of life metrics, inpatient status, and subgroup analyses are important for examining the role of palliative therapies other than chemotherapy in metastatic esophageal cancer and future studies are warranted.

The effect of Andrographis paniculata water extract on palliative management of metastatic esophageal squamous cell carcinoma—A phase II clinical trial

“…Hence, palliative care should consider a balance between treatment effects and quality of life care (Grunberger et al, 2007). Kim et al reported the impact of palliative therapy on 1493 patients with esophageal cancer not receiving chemotherapy and found that there is no difference in overall survival between those who received palliative therapy against those who did not receive palliative therapy (Kim, DiPeri, et al, 2020). The overall survival for those who received palliative therapy was only 2.83 months.…”

“…Moreover, there are usually significant issues in relation to SEMS shortly after placement, including recurrence of dysphagia due to tumor ingrowth or overgrowth in 8–10 weeks. Meanwhile, recent development in palliative chemotherapy may achieve better overall survival compared to the best supportive care (Janmaat et al, 2017; Kim, DiPeri, et al, 2020). However, the systemic toxicity of palliative chemotherapy for metastatic ESCC is high which posed a major impact on the quality of life for patients in their remaining period of survival (van Rossum et al, 2018).…”

Palliative care in metastatic head and neck cancer

“…Reassuringly, comparisons between SEER, a population‐based database, and the NCDB, a sample of convenience, have found that their populations have similar outcomes despite differences in sampling methods 34,38 . Furthermore, the NCDB is a well‐utilized tool for evaluation of palliative care utilization in many other cancer types, such as in colorectal cancer, penile cancer, and esophageal cancer 27,39,40 . Thus, though the data must be viewed in the context of the inherent limitations, we believe it is an appropriate way to analyze palliative care utilization in stage IVc head and neck cancer.…”

The association between mortality and use of Chinese herbal medicine among incident stage IV esophageal cancer patients: A retrospective cohort study with core herbs exploration

“…In addition, two outpatient visits or one inpatient record of hypertension, type 2 diabetes mellitus (DM), myocardial infarction (MI), chronic obstructive pulmonary disease (COPD), cirrhosis, hepatitis B, hepatitis C, chronic kidney disease (CKD), and cerebrovascular diseases (CVD) within 1 year before the diagnosis of EC were considered as comorbidities. Also, Charlson Comorbidity Index (CCI) was used to summarize EC patients’ comorbidities and as an indicator associated with OS ( Kim et al, 2020 ; Kubo et al, 2021 ). The diagnosis codes used in this study are listed in the Supplementary Table S1 .…”