Evaluating the Impact on Quality of Life of Chemoradiation in Gastric Cancer

Objective: Our phase I study prospectively evaluated quality of life (QOL) in patients undergoing adjuvant chemoradiation for gastric adenocarcinoma. Methods: Thirty-three patients receiving radiotherapy (45 Gy in 25 fractions), together with 12 weeks of infusional 5-fluorouacil and escalating doses of cisplatin every 2 weeks, completed the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 at five time points: baseline, completion of radiation, 4 weeks after completion of radiation, 6–12 months after completion of chemoradiation, and 2–3 years after completion of chemoradiation. Results: Mean age of the patients was 56 years (range: 31–77 years); 55% of the patients were male. Median followup was 2.7 years (range: 0.3–5 years). The 3-year overall survival was 83%. Five patients experienced dose-limiting toxicity (DLT). Median scores on global QOL and on the social, role, emotional, nausea and vomiting, and fatigue scales showed clinically and statistically significant worsening at completion of radiation. Statistical but not clinical worsening was found for the physical and appetite scales. By 6–12 months, no subscale showed a difference, on average, from the baseline score. However, up to 45% of the patients remained below baseline on at least 1 subscale. Patients with DLT had worse scores on the emotional and the nausea and vomiting scales. Scores for global QOL and for nausea and vomiting were significantly associated with chemotherapy dose. Conclusions: During chemoradiation, QOL is impaired. Although most scores return to baseline, recovery may take 6–12 months, and subscale scores remain below baseline in a significant proportion of patients.