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Education level and health-related quality of life after oesophageal cancer surgery: a nationwide cohort study
  1. Anna Regina Schandl,
  2. Asif Johar,
  3. Kalle Mälberg,
  4. Pernilla Lagergren
  1. Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
  1. Correspondence to Anna Regina Schandl; anna.schandl{at}


Objective The purpose of the study was to investigate whether low education level was associated with patients’ health-related quality of life (HRQOL) after oesophageal cancer resection.

Setting A nationwide cohort study in Sweden.

Participants In total, 378 patients who underwent oesophageal cancer surgery in 2001–2005 were followed up 6 months and 3 years after surgery.

Outcome measures HRQOL was assessed by the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (QLQ-C30) and the oesophageal cancer-specific module. The association between level of education and HRQOL was calculated with linear regression models, providing mean score differences (MD) and 95% CIs. Data were analysed separately for women and men.

Results Education level was not associated with HRQOL recovery after oesophageal cancer surgery. However, when data were stratified by sex, lower education was associated with worse emotional function (MD −13; 95% CI −22 to −3), more symptoms of insomnia (MD 20; 95% CI 8 to 32) and reflux (MD: 15; 95% CI 3 to 26) for women, but not for men. Among women, low education was in general associated with worse functioning and more symptoms.

Conclusions Low education was not associated with worse HRQOL after oesophageal cancer surgery. However, when data were stratified for sex, low education level was associated with worse functioning and more symptoms in certain HRQOL domains for women, particularly in a short-term perspective. For men, no such association was found.

  • hrqol
  • long-term follow-up
  • oesophageal neoplasm
  • cancer survivorship

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  • Contributors ARS, AJ, KM and PL contributed with input in designing the study. Data collection and assembly of data were performed by PL. Data analysis was conducted by AJ. All authors (ARS, AJ, KM and PL) contributed in interpreting the results, manuscript writing and approval of the final version of the manuscript.

  • Funding This work was supported by the Swedish Cancer Society (Grant number: 140323) and the Cancer Research Foundations of Radiumhemmet (Grant number: 141223).

  • Disclaimer The funding sources had no role in the design and conduct of the data collection, management, analysis and interpretation of the data or preparation review or approval of the manuscript.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval The study is approved by the Regional Ethical Review Board, Stockholm, Sweden.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All data underlying the findings are presented in the manuscript. The original database is not accessible through public repository, but available from the Swedish Esophageal and Cardia Cancer Registry at Karolinska Institutet, whose authors may be contacted at

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