Improvement of postoperative quality of life in patients with esophageal squamous cell carcinoma: does tea consumption have a role? | BMC Public Health

Follow-up results

Between December 1, 2014 and March 15, 2021, 466 postoperative male patients were enrolled in the study, 176 of whom were eliminated due to lack of partial baseline information, leaving 290 postoperative male ESCC patients enrolled in the study. Even distribution of baseline characteristics in the inclusion and exclusion groups (see supplement Table 1). The median follow-up of this study was 35 months (3-72 months), and 77 of the 290 patients died during the study period, with 1-, 3-, and 5-year survival rates of 92.3% (95% CI :0.885-0.949), 76.9% (95% CI:0.708-0.819), and 64.4% (95% CI:0.571- 0.712) (see supplement Table 2).

Effect of postoperative tea consumption on male postoperative patients with ESCC

Demographic and clinical characteristics

In this study, 290 male postoperative patients with ESCC were included, there was no statistical difference in age, chemotherapy, and TNM stage between the two groups of non-tea drinkers and tea drinkers after surgery (P> 0.05) (Table 1). In addition, the p-value for age was 0.051 for the tea drinking and non-tea drinking groups, therefore, stratified analysis by age, the result indicated that tea consumption had the same effect on quality of life among different age groups (see supplement Table 3 and supplement Table 4).

Table 1 Baseline demographic and clinical characteristics of male post-ESCC patients

Baseline quality-of-life scores

Median and quartiles were used to describe baseline quality of life scores. The Mann-Whitney test showed differences between the two groups in the domains of social functioning (P = 0.024) and insomnia (P = 0.005) on the EORTC QLQ-C30 scale, with no differences in baseline scores for the remaining functional domains (P > 0.05); the EORTC QLQ-OES18 scale no differences in baseline scores for all functional domains (P > 0.05) (Table 2).

Table 2 Preoperative EORTC scale baseline scores in male post-ESCC patients

Time to deterioration of quality of life

Compared to the non-tea drinking group, patients in the postoperative tea drinking group had global health status (P = 0.016), physical function (P = 0.004), role function (P = 0.042), emotional function (P= 0.007), cognitive function (P= 0.010), fatigue (P= 0.032), nausea and vomiting (P= 0.015), dyspnea (P= 0.040), appetite loss (P= 0.017), constipation (P= 0.004), diarrhea (P= 0.040), eating problems (P= 0.006), odynophagia (P= 0.001), trouble swallowing saliva (P< 0.001), choking when swallowing (P= 0.006), dry mouth (P= 0.002), trouble with taste (P= 0.001), cough (P< 0.001) and speech problems (P< 0.001) were all delayed in TTD (Table 3). Supplement Table 5 shows the number of patients with deterioration in each domain at each follow-up time point and their percentage of all patients deteriorating in that domain.

Table 3 Determination of clinically meaningful time to deterioration in the EORTC QLQ –C30/EORTC QLQ –OES18 scale in two groups of male ESCC patients who do not drink tea and drink tea after surgery

Association between tea consumption and the EORTC QLQ-C30/EORTC QLQ-OES18 scale

Multivariate Cox regression analysis showed that postoperative tea consumption improved physical function (HR = 0.722, 95% CI: 0.559-0.933), role function (HR = 0.740, 95% CI: 0.557-0.983), eating problems (HR = 0.718, 95 % CI: 0.537-0.960), odynophagia (HR = 0.682, 95% CI: 0.492-0.945), trouble swallowing saliva (HR = 0.624, 95% CI: 0.444-0.877), coughing (HR = 0.627, 95% CI: 0.442-0.889) and speech problems (HR = 0.631, 95% CI: 0.441-0.903) (Table 4).

Table 4 Association between tea consumption and EORTC QLQ-C30/EORTC QLQ-OES18 scales

Next, we further explored the effects of type, frequency, and duration of tea consumption on the quality of life in ESCC patients. Supplement Table 6 presents the association between different types of tea and quality of life. Unfermented tea plays a positive role in eating problems (HR = 0.584, 95% CI: 0.361-0.944), trouble swallowing saliva (HR = 0.553, 95% CI: 0.321-0.950), choking when swallowing (HR = 0.487, 95% CI: 0.279-0.853), coughing (HR = 0.546, 95% CI: 0.312-0.959), and speech problems (HR = 0.490, 95% CI: 0.269-0.893). Semi-fermented tea improved physical function (HR = 0.724, 95% CI: 0.525-0.998) and trouble swallowing saliva (HR = 0.621, 95% CI: 0.397-0.971), and observed that odynophagia (HR = 0.176, 95% CI : 0.043-0.720), coughing (HR = 0.291, 95% CI: 0.091-0.928), and speech problems (HR = 0.300 95% CI: 0.094-0.959) could be improved by other types of tea, while no association of fully fermented tea with quality of life was observed.

Table 5 presents the association between the frequency and duration of tea consumption and quality of life in ESCC patients. Drinking tea less than 5 times per week could improve trouble swallowing saliva (HR = 0.359, 95% CI: 0.190-0.677), choking when swallowing (HR = 0.576, 95% CI: 0.336-0.989), and coughing (HR = 0.445 , 95% CI: 0.247-0.803), and drinking more than 5 times per week had an improving effect on physical function (HR = 0.728, 95% CI: 0.549-0.965), role function (HR = 0.686, 95% CI: 0.499-0.943), constipation (HR = 0.597, 95% CI: 0.392-0.911), and speech problems (HR = 0.637, 95% CI: 0.429-0.947). In addition, there were observed for drinking tea for less than 30 years improved odynophagia (HR = 0.0.639, 95% CI: 0.424-0.964), trouble swallowing saliva (HR = 0.615, 95% CI: 0.401-0.942), choking while swallowing (HR = 0.628, 95% CI: 0.410-0.960), coughing (HR = 0.488, 95% CI: 0.306-0.779), and speech problems (HR = 0.595, 95% CI: 0.373-0.951). Meanwhile, it was observed that tea drinking for over 30 years could improve trouble swallowing saliva (HR = 0.613, 95% CI: 0.381-0.985) and dry mouth (HR = 0.602, 95% CI: 0.377-0.962).

Table 5 Association between frequency and duration of tea consumption and EORTC QLQ-C30/EORTC QLQ-OES18 scales

Association between preoperative and postoperative changes in tea drinking habits and quality of life in 290 male patients with esophageal squamous carcinoma

The above results suggest that postoperative tea drinking can improve multiple scales of quality of life in male ESCC postoperative patients, but many patients’ preoperative and postoperative tea drinking habits change, and what effect the change will have on patients’ quality of life we ​​do not know. Therefore, we stratified 290 patients by preoperative tea consumption to further investigate the association between preoperative and postoperative changes in tea drinking habits and quality of life. Among them, 65 were preoperative non-tea drinkers and 225 were tea drinkers.

Association between change in tea drinking habits and quality of life after surgery in 65 patients who did not drink tea before surgery

The results showed that the median TTD in the postoperative tea drinking group was 40.94 months [IQR: 21.77, 64.10] compared with the median TTD of 22.57 months [IQR: 11.47, 36.76] in the non-tea-drinking group, and the TTD in the cough domain was delayed (P= 0.034) (Supplementary Table 7).

The association between tea consumption and the EORTC QLQ-C30/EORTC QLQ-OES18 scale in 65 male ESCC patients was analyzed using a multivariate Cox regression model, and no association was found (P> 0.05) (Supplementary Table 8).

Association between change in tea drinking habits and quality of life after surgery in 225 patients who drank tea before surgery

Compared to the non-tea drinking group, patients in the postoperative tea drinking group had better global health status (P= 0.018), physical function (P= 0.006), role function (P= 0.012), emotional function (P= 0.004) cognitive function (P= 0.013), insomnia (P= 0.026), appetite loss (P= 0.019), constipation (P= 0.013), eating problems (P= 0.013), odynophagia (P= 0.002), trouble swallowing saliva (P< 0.001), and choking when swallowing (P= 0.003), dry mouth (P= 0.004), trouble with taste (P= 0.001), cough (P= 0.001) and speech problems (P< 0.001) were all delayed in TTD (Supplement Table 9).

Multivariate Cox regression analysis showed that postoperative tea consumption improved global health status (HR= 0.725, 95%CI: 0.541-0.972), physical function (HR= 0.689, 95%CI: 0.518-0.917), role function (HR= 0.678, 95%CI: 0.493-0.933), eating problems (HR= 0.701, 95%CI: 0.502-0.980), odynophagia (HR= 0.679, 95%CI: 0.469-0.983), trouble swallowing saliva (HR= 0.596, 95%CI: 0.407-0.872), cough (HR= 0.615, 95%CI: 0.417-0.907), and speech problems (HR= 0.556, 95%CI: 0.372–0.830) (Supplementary Table 10).

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