Education level and health-related quality of life after oesophageal cancer surgery: a nationwide cohort study

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.