A longitudinal study on the impact of cadmium exposure on quality of life in esophageal squamous cell carcinoma patients in Southern China

Despite evidence linking cadmium (Cd) to poor cancer outcomes, its association with quality of life in esophageal squamous cell carcinoma (ESCC) patients remains unexplored. This study aimed to investigate the association. This prospective cohort analysis includes 414 newly diagnosed ESCC patients with a 6.5-year follow-up. The EORTC QLQ-C30 and EORTC QLQ-OES18 were used to assess health-related quality of life (HRQoL). The QoLR package was used to calculate the HRQoL scores and determine time to deterioration(TTD) events. The effect of plasma Cd level on the HRQoL was assessed using Cox regression analysis. In the longitudinal TTD analysis, after controlling for potential confounders (age, gender, tumor location, clinical/pathological stage, and treatment modalities), higher plasma Cd levels were consistently associated with a significantly increased risk of deterioration in emotional functioning(HR = 1.466, 95%CI:1.079-1.993), eating problems(HR = 1.440, 95%CI: 1.054-1.968), choking when swallowing(HR = 1.637, 95% CI: 1.194-2.244), and trouble with taste(HR = 1.525, 95%CI: 1.093-2.128). These associations remained robust after adjustment for lifestyle and socioeconomic factors and were validated by bootstrap resampling analysis. Plasma Cd level may be a contributing factor to the deterioration of multiple HRQoL indicators.