Quality of Life and Real-Time Patient Experience During Neoadjuvant Therapy

Background: Neoadjuvant therapy (NT) is increasingly used for patients with localized gastrointestinal (GI) cancers. There is little data assessing patient experience and quality of life (QOL) during NT for GI cancers. Objective: To use a customized smartphone application to prospectively measure QOL and the real-time patient experience during NT. Methods: Patients with GI cancers receiving NT were instructed on using a customized smartphone application through which the Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire, a validated measure of health-related (HR) QOL, was administered at baseline, every 30 days, and at completion of NT. Participants also tracked their mood, symptoms, and used free-text journaling functionalities in the application. Mean overall and sub-section HRQOL scores were calculated during NT. Results: Among 104 enrolled patients, mean age was 60.5±11.5 years and 55% were male. Common cancer diagnoses were colorectal (40%), pancreatic (37%), and esophageal (15%). Mean overall FACT-G scores did not change during NT ( P =0.987). While functional wellbeing scores were consistently the lowest and social wellbeing scores the highest, FACT subscores similarly did not change during NT (all P >0.01). The most common symptoms reported during NT were fatigue, insomnia, and anxiety (39.3%, 34.5%, and 28.3% of patient entries, respectively). Qualitative analysis of free-text journaling entries identified anxiety, fear, and frustration as the most common themes, but also the importance of social support systems and confidence in health care providers. Conclusions: While patient symptom burden remains high, results of this prospective cohort study suggest QOL is maintained during NT for localized GI cancers.