Of the total 275 cases participated in the study, oesophageal to gastric cancer ratio was about 1.6 compared to 2 in the closest province, Golestan, where the highest rate of oesophageal cancer is seen.[26
] In the present study, mean age and male–female ratio were lower than the western countries,[27
] which indicates that morbidity risk of upper gastrointestinal cancer in female is near to male in this sample population. Staging of tumor, frequency distribution shows the lower stage tumor as the same as developing countries.[29
] In this study, most of the patients were male (57.8%) and when adjusted for sex and tumor site, the majority of patients with esophageal cancer were female and in the other sub-site of upper GI cancer males prevailed, while in the previous report all sub-sites were higher in men.[26
] A higher proportion of patients were from urban areas whilst in Malekzadeh et al
study the proportion of urban residence in upper GI cancers was 29-45%.[7
] Same as the other study,[31
] the majority of cancer site in oesophagus was in lower third segment, while in the previous study in Golestan[8
] and Hong Kong[32
] it was reported mainly in the middle third.
There was no statistically significant difference in functional and symptom scales and single items of EORTC QLQ-C30. However, anxiety scale and a few single items of EORTC QLQ-OG25 such as eating with other, body image, chocking and weight loss, in different tumor sites, which differs from previous reports, where differences in social function scale and three scales of QLQ-OG25 and some of its single items were seen.[25
In the present study, sex was not associated with major quality of life functions or symptom scores except financial problems, that the score is higher in men, indicating more financial difficulties in men. In Hagedoorn study, women either cancer patients or as caregivers had impaired quality of life and more psychological distress, while male cancer patients or male partners had impaired role function and quality of life and psychological distress in male patients was as same as female patients and female partners.[34
Statistically significant differences in quality of life scores by different tumor site were seen especially in anxiety scale, body image item, choking and weight loss (all with P
value < 0.05) which differed from the other study.[25
] This may indicate that patients suffering from upper GI cancer are prone to a variety of symptoms which warrant appropriate individual-based care provision. Moreover, similar to other studies, there were statistically significant differences in quality of life scores by treatment intent, either oesophageal cancer patients[27
] or gastric cancer patients,[35
] who received curative treatments, had better quality of life in more function and symptom scales and single items at baseline assessments.[27
Unlike similar studies,[37
] patients resided in rural areas had better QOL scores especially in EORTC QLQ-OG25 symptom scales and single items, which may enroot in the prevalent type of cancer (adenocarcinoma) and higher stages which are seen in patients resided in urban areas in this study. The main limitation of this study was incomplete staging for all patients; this could be improved in a prospective design, with accurate recording of tumor features both clinical and pathological staging.
In conclusion, the findings of this study show that SCC is predominant type of upper GI cancer in Khorasan provinces near the high risk area in Iran and this type of cancer seems to be distributed among both sex and amongst both urban and rural inhabitants. Likewise, higher frequency of tumor in lower third of esophageal and gastric cardia show epidemiologic shift in upper GI cancer. So, further studies are needed to explore these changes to determine the pre-disposing risk factors. While there was no significant difference in functional and symptom scales and single items of EORTC QLQ-C30, as the generic HRQL tool in malignancies, the specific health-related quality of life tool (EORTC QLQ-OG25) was able to distinguish most of the symptoms in patients with upper GI cancer. Therefore, it is highly recommended to administer this specific tool as a routine clinical assessment of OG cancer patients’ care in various inpatient and outpatient settings.