Health-related quality of life among patients cured by surgery for esophageal cancer

The role of trait emotional intelligence in quality of life, anxiety and depression symptoms after surgery for esophageal or gastric cancer: A French national database FREGAT

OBJECTIVE

The main objective was to test the indirect effects of emotional competence (EC) after diagnosis (T1) on the health-related quality of life (HRQoL) after surgery (T2) of esogastric cancer patients via fewer anxiety and depression symptoms (T2).

METHODS

Data were collected from 30 French centers via the clinicobiological database French EsoGastric Tumors (FREGAT). Two hundred and twenty-eight participants completed a self-reported questionnaire at T1 and T2, assessing their EC (Profile of Emotional Competence (PEC)), HRQoL (EORTC Quality of Life Questionnaire-Core (QLQ-C30)), and anxiety and depression symptoms (Hospital Anxiety and Depression Scale (HADS)). Regression analyses were used to test the direct effects of intrapersonal and interpersonal EC on their anxiety/depression symptoms and HRQoL at T1 and T2. The PROCESS Macro in SPPS v.22 with bootstrap methods was used to test the indirect effects of intrapersonal and interpersonal EC at T1 on HRQoL at T2 via anxiety and depression symptoms.

RESULTS

EC predicted fewer anxiety and depression symptoms of patients at T1 and T2 and better HRQoL at T1. EC at T1 also predicted a better HRQoL at T2 via fewer anxiety and depression symptoms at T2.

CONCLUSIONS

Patients who tended to use their EC in daily life could be more effective in regulating the emotional impact of the cancer diagnosis and surgery. This explains why they reported fewer anxiety and depression symptoms, which in turn enabled a better perceived HRQoL after surgery. Therefore, reinforcing the use of patients' EC in daily life following their diagnosis could decrease their emotional distress and, in this way, improve their HRQoL in the preoperative and postoperative stages.

The role of rehabilitation in patients undergoing oesophagectomy for cancer and pre-malignant disease: A qualitative exploration of the views of patients, carers and healthcare providers

OBJECTIVE

Oesophagectomy for cancer is associated with significant morbidity and mortality, and reduced quality of life. Structured rehabilitation potentially offers improved physical and psychological outcomes. We aimed to explore patient, carer and healthcare provider attitudes and preferences towards the role of rehabilitation.

METHODS

We interviewed 15 patients who had undergone an oesophagectomy, 10 carers and 13 healthcare providers about perceived impacts of treatment; preferred components of a rehabilitation program; barriers/enablers of support provision; and participation in rehabilitation programs. Data were analysed using framework analysis.

RESULTS

The overarching theme was "Getting back to normal." Diagnosis of disease signified a disruption to the normal trajectory of patients' lives and the post-treatment period was characterised as striving to return to normal. Patients and carers focused on rehabilitation needs post-treatment including dietary support, physiotherapy and healthcare provider support. Healthcare providers described rehabilitation as potentially beneficial from the pre-treatment phase and, along with carers, highlighted the importance of psychological support. Barriers included access to services, cost of service provision and appointment burden.

CONCLUSION

A need for rehabilitation services was identified by healthcare providers from the point of diagnosis, rather than only after surgery. Implications include improved service provision by healthcare institutions for patients undergoing oesophagectomy.

Early Oral Feeding Following McKeown Minimally Invasive Esophagectomy: An Open-label, Randomized, Controlled, Noninferiority Trial

OBJECTIVE

Our objective was to evaluate the impact of early oral feeding (EOF) on postoperative cardiac, respiratory, and gastrointestinal (CRG) complications after McKeown minimally invasive esophagectomy for esophageal cancer.

SUMMARY BACKGROUND DATA

Nil-by-mouth with enteral tube feeding is routinely practiced after esophagectomy.

METHODS

Patients were randomly allocated to receive oral feeding on the first postoperative day (EOF group) or late oral feeding (LOF group) 7 days after surgery. The primary endpoint was the occurrence of postoperative CRG complications, and the secondary outcomes included bowel function recovery and short-term quality of life (QOL).

RESULTS

Between February 2014 and October 2015, 280 patients were enrolled in this study. There were 140 patients in the EOF group and 140 patients in the LOF group. EOF was noninferior to LOF for CRG complications (30.0% in the EOF group vs. 32.9% in the LOF group; 95% confidence interval of the difference: -13.8% to 8.0%). Compared with the LOF group, the EOF group showed significantly shorter time to first flatus (median of 2 days vs. 3 days, P = 0.001) and bowel movement (median of 3 vs. 4 days, P < 0.001). Two weeks after the operation, patients in the EOF group reported higher global QOL and function scores and lower symptom scores than patients in the LOF group.

CONCLUSIONS

In patients after McKeown minimally invasive esophagectomy is noninferior to the standard of care with regard to postoperative CRG complications. In addition, patients in the EOF group had a quicker recovery of bowel function and improved short-term QOL.

Risk factors for loss of bone mineral density after curative esophagectomy

Micronutrient and fat malabsorption and altered enteroendocrine signaling occur after esophagectomy for cancer; however, the impact of malnutrition on bone health in this cohort has not been previously investigated. In this study, the prevalence of osteoporosis increased after curative surgery, associated with disease-specific, treatment-related, and population risk factors.

PURPOSE

Improved oncologic outcomes in esophageal cancer (EC) have resulted in increased survivorship and a focus on long-term quality of life. Malnutrition and micronutrient malabsorption are common among patients with EC, but the effect on bone metabolism is not known. The aim of this study was to characterize changes in bone mineral density (BMD) following curative esophagectomy.

METHODS

Consecutive disease-free patients who underwent esophagectomy with gastric conduit for pathologically node-negative disease from 2000 to 2014 were included. BMD was assessed at vertebral levels T12-L5 by computed tomography using a simple trabecular region-of-interest attenuation technique, and serum markers of nutritional status and bone metabolism were examined. Independent risk factors for osteoporosis were identified by multivariable logistic regression.

RESULTS

Seventy-five consecutive patients were studied. Osteoporosis was present in 25% at diagnosis. BMD declined at 1 and 2 years postoperatively (144.3 ± 45.8 versus 128.6 ± 46.2 and 122.7 ± 43.5 Hounsfield Units (HU), P < 0.0001), with increased osteoporosis prevalence to 38% and 44% (P = 0.049), respectively. No significant postoperative change in vitamin D, calcium, or phosphate was observed, but alkaline phosphatase increased significantly (P < 0.001). While female sex (P = 0.004) and ASA grade (P = 0.043) were independently associated with osteoporosis at diagnosis, age (P = 0.050), female sex (P = 0.023), smoking (P = 0.024), and pathologic T stage (P = 0.023) were independently predictive of osteoporosis at 1 year postoperatively.

CONCLUSIONS

Osteoporosis is prevalent among disease-free patients post-esophagectomy for EC, associated with disease-specific, treatment-related, and population risk factors. Strategies which minimize BMD decline should be considered to avoid fragility fractures in this cohort.

Determining Overall Survival and Risk Factors in Esophageal Cancer Using Censored Quantile Regression

Background: Esophageal cancer is one of the leading causes of death worldwide. The global increasing rate of this type of cancer requires more attention. The purpose of this study was to determine the overall survival probability of esophageal cancer after diagnosis and to assess the potential risk factors in a population of Iranian patients. Materials and Methods: This retrospective cohort study was conducted on 127 cases with esophageal cancer in the Azarbaijan province, East of Iran. Participants in the study were diagnosed during 2009-2010 and were followed up for 5 years. The event was considered death due to esophageal cancer and those who survived until the end of the study were assumed as right censored. Censored quntile regression was fitted to find the overall survival of the patients using adjusted effects of variables and was compared with Cox regression model. Results: Patients’ mean and median survival time were 16.99 and 10.06 months respectively and 89% off cases died by the end of the study. The 1, 3, 6, 12 and 36-month survival probabilities were 0.95, 0.76, 0.60, 0.43, and 0.18. The median survival time for females and males without surgery were 21.79 and 14.76 month respectively. The accuracy of predictions were 0.99 and 0.74 for the censored quantile regression and Cox, respectively. Conclusion: We concluded that being male, not having surgery, longer wait time between having symptoms and being diagnosed, low socioeconomic status and old age to be significant risk factors in reducing the probability of survival from esophageal cancer.

Physical Activity Among Postoperative Esophageal Cancer Patients

BACKGROUND

Previous literature has reported that regular physical activity enhances health-related quality of life for cancer patients. However, there is a lack of studies that focus on physical activity among postoperative esophageal cancer patients.

OBJECTIVE

The aims of this study were to (1) describe the prevalence of physical activity among postoperative esophageal cancer patients, (2) explore variables related to physical activity (demographics, nutrition, dysphagia, and health-related qualify of life), and (3) examine potential reasons for inactivity among participants who scored low using case studies.

METHODS

In this cross-sectional design, physical activity was evaluated by the Japanese version of the International Physical Activity Questionnaire. Variables were analyzed using Spearman rank correlation coefficients, Mann-Whitney U tests, or Fisher exact tests.

RESULTS

Fifty-eight patients participated in this study; 79% met the recommended physical activity guidelines. Present occupational status and past leisure-time physical activity behavior before the cancer diagnosis were related to current leisure-time physical activity and meeting the guidelines postoperatively. Participants who scored 0 (little or no activity) in the questionnaire also scored low in health-related quality of life.

CONCLUSIONS

Participants performed especially well in physical activity related to leisure time and transportation. Positive reinforcement is needed for patients who perform adequate levels of physical activity, and reviewing the benefits of regular physical activity is encouraged for all.

IMPLICATIONS FOR PRACTICE

Occupational status and past leisure-time physical activity before diagnosis can be indicators for promoting physical activity among postoperative esophageal cancer patients. Inactive participants should be supported to promote both physical activity and health-related qualify of life.

Factors Affecting Long-Survival of Patients with Esophageal Cancer Using Non-Mixture Cure Fraction Model

Objective:

Esophageal cancer (EC) is one of the gastrointestinal malignancies with a very high morbidity and mortality rate due to poor prognosis. This study aims to assess the effects of risk factors on survival and cure fraction of patients with EC in a population of Iranian patients using a non-mixture cure fraction model.

Methods:

This retrospective cohort study was conducted on 127 patients with EC who were diagnosed during 2009-2010 and were followed up for 5 years in East-Azarbaijan, Iran. Stepwise selection and non-mixture cure fraction model were used to find the risk factors of EC survival patients.

Results:

The mean (±standard deviation) diagnosis age of the EC was 66.92(±11.95). One, three and five-year survival probabilities were 0.44 (95% confidence interval (CI): 0.36-0.54), 0.2 (95% CI: 0.14-0.28) and 0.13 (95% CI: 0.08-0.2) respectively. Female sex (Estimate=-0.99; 95% confidence interval (CI): -1.41,-0.58; p-value<0.001), low level socioeconomic status (Estimate=0.39; 95%CI: 0.12,0.66; p-value=0.043), the group who did not do esophagectomy surgery (Estimate=0.58; 95%CI: 0.17,0.99; p-value=0.005) and unmarried group (Estimate=0.58; 95%CI: 0.11-1.05; p-value=0.015) were found as the significant predictor of survival and cure fraction of the EC patients. Population cure rate was 0.11 (95%CI: 0.07-0.19) and Cure fraction was estimated 5.11 percent.

Conclusion:

This study found gender, socioeconomic status, Esophagectomy surgery and marital status as the potential risk factors for survival and cure fraction of Iranian EC patients. Moreover, non- mixture cure fraction provides more accurate and more reliable insight into long-term advantages of EC therapy compared to standard classic survival analysis alternatives.

Profiles of patient and tumour characteristics in relation to health-related quality of life after oesophageal cancer surgery

Strong deterioration in health-related quality of life (HRQOL) is a major concern in a sub-group of long-term oesophageal cancer survivors. This study aimed to identify potential clustering of patients and tumour variables that predicts such deterioration. Patient and tumour variables were collected in a prospective cohort of patients who underwent surgery for oesophageal cancer in Sweden 2001-2005. Latent cluster analysis identified statistically significant clustering of these variables. Multivariable logistic regression adjusted for age, BMI, tumour stage and marital status was used to determine odds ratios (ORs) with 95% confidence intervals (CIs) between patient profiles and HRQOL at 3 and 5 years from surgery. Among 155 included patients at 3 years, three patient profiles were identified: 1) 'reference profile' (males, younger age, employed, upper secondary education, co-habitating, urban dwellers, adenocarcinoma and advanced tumour stage) (n = 47;30%), 2) 'adenocarcinoma profile' (middle age, unemployed/retired, males, low education, co-habitating, adenocarcinoma, advanced tumour stage, tumour in lower oesophagus/cardia, and co-morbidities (n = 79;51%), and 3) 'squamous-cell carcinoma profile' (unemployed/retired, middle-age, males, low BMI, urban dwellers, squamous-cell carcinoma, tumour in upper/middle oesophagus (n = 29;19%). These profiles did not differ regarding most HRQOL measures. Exceptions were the squamous-cell carcinoma profile, reporting more constipation (OR = 5.69; 95%CI: 1.34-24.28) and trouble swallowing saliva (OR = 4.87; 95%CI: 1.04-22.78) and the adenocarcinoma profile reporting more dyspnoea (OR = 2.60; 95%CI: 1.00-6.77) and constipation (OR = 3.31; 95%CI: 1.00-10.97) compared to the reference profile. Three distinct patient profiles were identified but these could not explain the substantial deterioration in HRQOL observed in the sub-sample of survivors.

Preoperative Nomogram to Risk Stratify Patients for the Benefit of Trimodality Therapy in Esophageal Adenocarcinoma

Purpose

To develop a nomogram that estimates 1-year recurrence-free survival (RFS) after trimodality therapy for esophageal adenocarcinoma and to assess the overall survival (OS) benefit of esophagectomy after chemoradiotherapy (CRT) on the basis of 1-year recurrence risk.

Methods

In total, 568 consecutive patients with potentially resectable esophageal adenocarcinoma who underwent CRT were included for analysis, including 373 patients who underwent esophagectomy after CRT (trimodality therapy), and 195 who did not undergo surgery (bimodality therapy). A nomogram for 1-year RFS was created using a Cox regression model. The upper tertile of the nomogram score was used to stratify patients in low-risk and high-risk groups for 1-year recurrence. The 5-year OS was compared between trimodality and bimodality therapy in low-risk and high-risk patients after propensity score matching, respectively.

Results

Median follow-up for the entire cohort was 62 months. The 5-year OS in the trimodality and bimodality treatment groups was 56.3% (95% confidence interval [CI] 47.9–64.7) and 36.9% (95% CI 31.4–42.4), respectively. The final nomogram for the prediction of 1-year RFS included male gender, poor histologic grade, signet ring cell adenocarcinoma, cN1, cN2-3, and baseline SUV_max, with accurate calibration and reasonable discrimination (C-statistic: 0.66). Trimodality therapy was associated with improved 5-year OS in low-risk patients (p = 0.003), whereas it showed no significant survival benefit in high-risk patients (p = 0.302).

Conclusions

The proposed nomogram estimates early recurrence risk. The addition of surgery to CRT provides a clear OS benefit in low-risk patients. The OS benefit of surgery in high-risk patients is less pronounced.

Electronic supplementary material

The online version of this article (10.1245/s10434-018-6435-4) contains supplementary material, which is available to authorized users.

Long-term quality of life after esophagectomy with gastric pull-up

BACKGROUND AND OBJECTIVES

Data on long-term health-related quality of life (HRQL) after esophagectomy for cancer show contradictory results. The aim was to analyze long-term HRQL at 3 or more years after esophagectomy.

METHODS

Survivors were identified among patients who had undergone esophagectomy during 2007-2013 using the local clinic database. Quality of life was assessed using the European Organization for Research and Treatment of Cancer QLQ-C30 and OG25 questionnaires. Specific aspects were selected a priori and compared with published scores from European healthy subjects (mean difference, MD).

RESULTS

Sixty-five long-term survivors (median follow-up 4 years) were identified. All functional scales and most symptom scales were clinically similar between EC long-term survivors and European healthy subjects. Survivors reported more problems concerning eating (MD 13.1, 95% C.I. 10.6-15.6) and reflux (MD 19.7, 95% C.I. 15.9-23.5). HQRL variation from discharge to long term was available in 27 participants who reported improvements in role functioning (MD 40.1, 95%C.I. 24.3-56.0) and dysphagia (MD -41.9, 95% C.I. -51.7 to 32.0).

CONCLUSIONS

Long-term HRQL after esophagectomy is similar between EC survivors and European healthy subjects, despite persisting reflux and eating problems. Further research may focus on improvements of postoperative alimentary habits.

Effect of Neoadjuvant Chemoradiotherapy on Health-Related Quality of Life in Esophageal or Junctional Cancer: Results From the Randomized CROSS Trial

Purpose

To compare pre-agreed health-related quality of life (HRQOL) domains in patients with esophageal or junctional cancer who received neoadjuvant chemoradiotherapy (nCRT) followed by surgery or surgery alone. Secondary aims were to examine the effect of nCRT on HRQOL before surgery and the effect of surgery on HRQOL.

Patients and Methods

Patients were randomly assigned to nCRT (carboplatin plus paclitaxel with concurrent 41.4-Gy radiotherapy) followed by surgery or surgery alone. HRQOL was measured using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire–Core 30 (QLQ-C30) and –Oesophageal Cancer Module (QLQ-OES24) questionnaires pretreatment and at 3, 6, 9, and 12 months postoperatively. The nCRT group also received preoperative questionnaires. Physical functioning (PF; QLQ-C30) and eating problems (EA; QLQ-OES24) were chosen as predefined primary end points. Predefined secondary end points were global QOL (GQOL; QLQ-C30), fatigue (FA; QLQ-C30), and emotional problems (EM; QLQ-OES24).

Results

A total of 363 patients were analyzed. No statistically significant differences in postoperative HRQOL were found between treatment groups. In the nCRT group, PF, EA, GQOL, FA, and EM scores deteriorated 1 week after nCRT (Cohen’s d: −0.93, P < .001; 0.47, P < .001; −0.84, P < .001; 1.45, P < .001; and 0.32, P = .001, respectively). In both treatment groups, all end points declined 3 months postoperatively compared with baseline (Cohen’s d: −1.00, 0.33, −0.47, −0.34, and 0.33, respectively; all P < .001), followed by a continuous gradual improvement. EA, GQOL, and EM were restored to baseline levels during follow-up, whereas PF and FA remained impaired 1 year postoperatively (Cohen’s d: 0.52 and −0.53, respectively; both P < .001).

Conclusion

Although HRQOL declined during nCRT, no effect of nCRT was apparent on postoperative HRQOL compared with surgery alone. In addition to the improvement in survival, these findings support the view that nCRT according to the Chemoradiotherapy for Esophageal Cancer Followed by Surgery Study–regimen can be regarded as a standard of care.

Influence of esophagectomy on the gastroesophageal reflux in patients with esophageal cancer

This study aims to assess the influence of esophagectomy with gastric transposition on the gastroesophageal reflux (GER) and gastric acidity in patients with esophageal cancer. Data on 53 esophageal cancer patients who underwent 24-hour impedance-pH monitoring after esophagectomy were retrospectively analyzed. We used a solid-state esophageal pH probe in which the esophageal pH sensor is placed 1.5 cm distal to the upper esophageal sphincter and the gastric pH sensor is located 15 cm distal to the esophageal pH channel. 24-hour impedance-pH monitoring data and other clinical data including anastomosis site stricture and incidence of pneumonia were collected. We defined pathologic reflux with reference to known normative data. Stricture was defined when an intervention such as bougienage or balloon dilatation was required to relieve dysphagia. The esophageal and gastric mean pH were 5.47 ± 1.51 and 3.33 ± 1.64, respectively. The percent time of acidic pH (<4) was 6.66 ± 12.49% in the esophagus and 70.53 ± 32.19% in the stomach. Esophageal pathologic acid reflux was noticed in 32.1%, 20.8%, and 35.8% during total, upright, and recumbent time, respectively. Esophageal pathologic bolus reflux was noted in 83.0%, 77.4%, and 64.2% during total, upright, and recumbent time, respectively. Gastric acidity increased with time after esophagectomy. Esophageal acid exposure time correlated with intragastric pH. However, esophageal pathologic acid reflux was not associated with anastomosis site stricture or pneumonia. In conclusion, GER frequently occurs after esophagectomy. Thus, strict lifestyle modifications and acid suppression would be necessary in patients following esophagectomy.

Impacts of treatments on the quality of life among esophageal squamous cell carcinoma patients

This study aims to investigate the effects of treatments on the quality of life for patients with esophageal squamous cell carcinoma patients diagnosed at early and late stages. From a medical center in central Taiwan, patients who had been diagnosed with esophageal squamous cell carcinoma from February 2007 and March 2011 were recruited. Using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) and the Quality of Life Questionnaire Oesophageal 18 (QLQ-OES18), quality of life scores for 105 esophageal squamous cell carcinoma patients were obtained and assessed. Multivariate analysis was performed on the quality of life scores after stratification by cancer stage. Among early-stage esophageal squamous cell carcinoma patients, those received only surgery (S-only) performed better in physical and social functioning compared with patients who underwent surgery and concurrent chemoradiotherapy (S+CCRT) (β = 9.0, P = 0.03; β = 12.1, P = 0.04, respectively). For those that received only concurrent chemoradiotherapy (CCRT-only), they performed worse in role and emotional functioning relative to S+CCRT patients (β = -17.2, P = 0.02; β = -15.7, P = 0.05, respectively). Among late-stage patients, CCRT-only treatment gave insignificantly better global health status and functional scale scores and less severe symptoms compared to the S+CCRT option. Better functional scores and less aggravated symptoms are observed in early-stage esophageal squamous cell carcinoma patients who received surgery-only treatment relative to those that underwent both surgery and chemoradiotherapy. For late-stage esophageal cancer patients, the measured difference of quality of life is not significant between CCRT-only and S+CCRT treatments.

Validation of EORTC QLQ-OES18 for Chinese patients with esophageal cancer

The aim of this study is to evaluate the reliability, validity, and acceptability of the Chinese version of the EORTC QLQ-OES18 in patients with esophageal cancer. The questionnaire was translated according to the guideline of the EORTC. One hundred and forty-nine patients with esophageal cancer from Tianjin Medical University Cancer Institute and Hospital completed the Karnofsky performance scale (KPS) and the simplified Chinese EORTC QLQ-C30/OES18 scales during July 2013 to January 2014. The results were statistically analyzed by Cronbach's α coefficient, Spearman correlation test with multiple strengthen analysis, and Wilcoxon Rank Sum test. The internal consistency (Cronbach's α coefficient) of all four scales (dysphagia, eating, reflux, and pain) was 0.689-0.822, which were satisfactory or near satisfactory. The absolute values of correlation of each scale between EORTC QLQ-OES18 and EORTC QLQ-C30 were 0.002-0.750 while there was no significant difference between groups divided by KPS scores. We confirmed the Chinese version of EORTC QLQ-OES18 appears to be a reliable, valid, and acceptable instrument for measuring the health-related quality of life of patients with esophageal cancer in mainland China.

Improved treatment decisions in patients with esophageal cancer

BACKGROUND

Patients with esophageal cancer seldom achieve long-term survival. This prospective cohort study investigated the selection of patients likely to benefit from curative treatment and whether information on patients' health-related quality of life (HRQL) would assist treatment decisions in the multidisciplinary team.

METHODS

Consecutive patients completed HRQL assessments and clinical data were collected before start of treatment. Logistic regression analyses identified clinical factors associated with treatment intent in patients with stage-III disease. Kaplan-Meier method was used for survival analyses and Cox proportional hazards models were used to assess the impact of clinical factors and HRQL on survival in patients planned for curative treatment.

RESULTS

Patients with curative treatment intent (n = 90) were younger, had better WHO performance status and less fatigue than patients with palliative treatment intent (n = 89). Median survival for the total cohort (n = 179) and patients with palliative or curative treatment intent was nine, five and 19 months, respectively. In multivariate Cox regression analyses, performance status (0-1 favorable) and comorbidity (ASA I favorable) were factors of importance for survival, whereas measures of HRQL were not.

CONCLUSIONS

Patients performance status and comorbidity must be considered in addition to stage of disease to avoid extensive curative treatment in patients with short life expectancy. This study did not provide evidence to support that information on patients HRQL adds value to the multidisciplinary team's treatment decision process.

Quality of Life after Open or Minimally Invasive Esophagectomy in Patients With Esophageal Cancer-A Systematic Review

Although esophageal cancer is rare in the United States, 5-year survival and quality of life (QoL) are poor following esophageal cancer surgery. Although esophageal cancer has been surgically treated with esophagectomy through thoracotomy, an open procedure, minimally invasive surgical procedures have been recently introduced to decrease the risk of complications and improve QoL after surgery. The current study is a systematic review of the published literature to assess differences in QoL after traditional (open) or minimally invasive esophagectomy. We hypothesized that QoL is consistently better in patients treated with minimally invasive surgery than in those treated with a more traditional and invasive approach. Although global health, social function, and emotional function improved more commonly after minimally invasive surgery compared with open surgery, physical function and role function, as well as symptoms including choking, dysphagia, eating problems, and trouble swallowing saliva, declined for both surgery types. Cognitive function was equivocal across both groups. The potential small benefits in global and mental health status among those who experience minimally invasive surgery should be considered with caution given the possibility of publication and selection bias.

Reduced fitness and physical functioning are long-term sequelae after curative treatment for esophageal cancer: a matched control study

Reduced physical functioning is common following resections for esophageal cancer; however, objective data on physical performance outcomes in this cohort are rare. The aim of this study was to assess the physical performance and health related quality of life (HRQOL) of disease free survivors and compare findings in a case matched noncancer control group. Twenty-five males (mean (±SD) aged 63 (±6) years) who were over 6 months postesophagectomy and disease-free were compared with 25 controls (60 ± 6 years). Physical functioning was assessed through hand grip strength (dynamometry), exercise capacity (incremental shuttle walk test), physical activity levels (RT3 accelerometer), and body composition (bio-electrical impedance analysis). Health-related quality of life was measured using the EORTC QLQ-C30 questionnaire. Esophageal cancer survivors demonstrated significantly lower fitness (P < 0.001) and time spent in moderate (P < 0.001) and vigorous (P < 0.001) intensity physical activity compared with controls. Global health status and quality of life were similar in both groups (P = 0.245); however, physical and role functioning domains were lower in the cancer survivors (P < 0.001, and P = 0.001, respectively). These data show that disease-free survivors of curative esophageal cancer treatment demonstrate a significant compromise in physical functioning compared with controls, thus highlighting the multiple, complex rehabilitative needs of this cohort.

Patient-Reported Outcomes in Thoracic Surgery

The existing thoracic surgical literature contains several retrospective and observational studies that include patient-reported outcomes. To deliver true patient-centered care, it will be necessary to universally gather patient-reported outcomes prospectively, including them in routine patient care, clinical registries, and clinical trials.

Quality of life and fear of cancer recurrence after endoscopic treatment for early Barrett's neoplasia: a prospective study

Endoscopic therapy is the treatment of choice for high grade intraepithelial neoplasia (HGIN) or early cancer (≤T1sm1) in Barrett's esophagus (BE). We prospectively evaluated the effect of endoscopic treatment on quality of life (QOL) and fear of cancer (recurrence) and compared this with the effect of Barrett's surveillance or surgery. Patients treated endoscopically for early Barrett's neoplasia (n = 42, HGIN - T1sm1N0M0) were compared with three groups: patients with non-dysplastic BE undergoing surveillance (n = 44); patients treated surgically for early BE neoplasia (HGIN - T2N0M0, n = 21); patients treated surgically for advanced BE cancer (T1N1M0 - T3N1M0, n = 19). QOL (SF-36; EORTC-QLQ-C30; EORTC-QLQ-OES18) and fear of cancer recurrence (Worry of Cancer Scale [WOCS] and the Hospital Anxiety and Depression Scale [HADS]) were measured at baseline, 2 and 6 months after treatment. The endoscopic treatment group reported significantly better QOL in both physical and mental scales of SF-36 and EORTC-QLQ-C30 and less esophageal cancer related symptoms compared to both surgical groups. The endoscopic treatment group reported significant more worry for cancer recurrence (WOCS) compared to the early surgical group. Their scores on the WOCS were comparable with the scores of the advanced surgical group. Endoscopic treatment of early esophageal cancer has less negative impact on QOL and esophageal cancer symptoms than surgery. However, endoscopically treated patients worry as much about cancer recurrence as patients treated surgically for advanced cancer.

Nurse Counseling for Physical Activity in Patients Undergoing Esophagectomy

Strong evidence exists regarding multiple benefits of physical activity among cancer patients. Patients undergoing esophagectomy received counseling for physical activity by a nurse and instructions to keep a diary of physical activities before surgery, followed by 2 counseling sessions after surgery. Physical activity, body mass index, psychological distress, and quality of life were measured at baseline, 2–4 weeks, and 3 and 6 months after discharge. Of 29 participants (mean age = 65.9 years), 72.5% underwent thoracoscopic esophagectomy in the prone position with 3-field lymphadectomy. The results of the International Physical Activity Questionnaire indicated that postoperative physical activity returned to nearly preoperative level, and the number of inactive patients gradually decreased by half at 6 months after discharge. Quality of life scores, except those for role function and social function, tended to return to the baseline at 6 months after discharge. Psychological distress measured by the Kessler 6 remained lower than the baseline, whereas the mean score of body mass index gradually declined after discharge. Patients undergoing esophagectomy and receiving nurse counseling can return to preoperative physical activity level in their daily lives after surgery. Nurses should integrate physical activity promotion into cancer care.

Toward improved survivorship: supportive care needs of esophageal cancer patients, a literature review

The growing prevalence of esophageal cancer survivors represent a population typified by an extensive treatment regime, significant postsurgical long-term effects, and a dismal prognosis. Despite this, little is known of the supportive care needs of this patient group and the extent to which these are being met in practice. This review provides a synthesis of the research evidence to date; emphasizing opportunities for clinical application and setting a future agenda with research priorities. A literature search was performed using Medline/Embase, PsycINFO, and Web of Science. Search headings used included; [esophagus] or [esopohageal] or [upper gastrointestinal] or [upper GI] AND [cancer] or [carcinoma] or [squamous cell] AND [supportive care] or [survivorship] or [psychological] or [emotional] or [information] or [social] or [communication] or [spiritual] or [health-related-quality-of-life] or [HRQL] or [qualitative] or [patient narrative] or [clinical nurse specialist] or [CNS]. Related articles in English were reviewed, with additional articles harvested from reference sections. Esophageal cancer survivors report significant late-term effects posttreatment, encompassing sustained impairment in most areas of health-related quality of life. With a necessitated change in eating behavior, survivors find it particularly challenging to adjust to a new social identity and as a cancer population report high levels of psychological morbidity. Although the determinants of psychological morbidity are largely unknown, illness representations may be a key contributor. Several multidisciplinary supportive care interventions have been developed with promising results. The research summarized in this paper provides valuable insight into the psychosocial well-being of the esophageal cancer survivor. However, knowledge gaps remain, alongside a dearth of applied examples in meeting supportive care need.

Systematic review of patient-reported outcome measures in the surgical treatment of patients with esophageal cancer

Esophageal cancer is currently the eighth most common cancer worldwide. Improvements in operative techniques and neoadjuvant therapies have led to improved outcomes. Resection of the esophagus carries a high risk of severe complications and has a negative impact on health-related quality of life (QOL). The aim of this study was to assess which patient-reported outcome measures (PROMs) are used to measure QOL after esophagectomy for cancer. A comprehensive search of original articles was conducted investigating QOL after surgery for esophageal carcinoma. Two authors independently selected relevant articles, conducted clinical appraisal, and extracted data (PJ and JS). Out of 5893 articles, 58 studies were included, consisting of 41 prospective and 17 retrospective cohort studies, including a total of 6964 patients. These studies included 11 different PROMs. The existing PROMs could be divided into generic, symptom-specific, and disease-specific questionnaires. The European Organisation for Research and Treatment of Cancer (EORTC) QOL Questionnaire Core 30 (QLQ C-30) along with the EORTC QLQ-OESophagus module OES18 was the most widely used; in 42 and 32 studies, respectively. The EORTC and the Functional Assessment of Cancer Therapy (FACT) questionnaires use an oncological module and an organ-specific module. One validation study was available, which compared the FACT and EORTC, showing moderate to poor correlation between the questionnaires. A great variety of PROMs are being used in the measurement of QOL after surgery for esophageal cancer. A questionnaire with a general module along with a disease-specific module for assessment of QOL of different treatment modalities seem to be the most desirable, such as the EORTC and the FACT with their specific modules (EORTC QLQ-OES18 and FACT-E). Both are developed in different treatment modalities, such as in surgical patients. With regard to reproducibility of current results, the EORTC is recommended.

The effect of a nurse led telephone supportive care programme on patients' quality of life, received information and health care contacts after oesophageal cancer surgery-A six month RCT-follow-up study

BACKGROUND

Following oesophagectomy, a major surgical procedure, it is known that patients suffer from severely reduced quality of life and have an unmet need for postoperative support. Still, there is a lack of research testing interventions aiming to enhance the patients' life situation after this surgical procedure.

AIM

The aim of the study was to evaluate the effect of a nurse led telephone supportive care programme on quality of life (QOL), received information and the number of healthcare contacts compared to conventional care following oesophageal resection for cancer.

METHOD

The study was designed as a randomized controlled trial (RCT) aiming to test the effect of a nurse led telephone supportive care program compared to conventional care. Patient assessments were conducted at discharge, 2 weeks, 2, 4 and 6 months after discharge and comprised evaluation of QOL, received information and the number of health care contacts. Statistical testing were conducted with repeated measurements analysis of variance to test if there were differences between the groups during follow-up.

RESULT

The results show that the intervention group was significantly more satisfied with received information for items concerning the information they received about things to do to help yourself, written information and for the global information score. The control group scored significantly higher on the item regarding wishing to receive more information and wish to receive less information. No effect of the intervention was shown on QOL or number of health care contacts.

CONCLUSION

Proactive nurse-led telephone follow-up has a significant positive impact on the patients' experience of received information. This is likely to have a positive effect on their ability to cope with a life that may include remaining side effects and adverse symptoms for a long time after surgery.

Lymphadenectomy and health-related quality of life after oesophageal cancer surgery: a nationwide, population-based cohort study

OBJECTIVE

The purpose of this study was to clarify whether more extensive surgical lymph node resection during oesophageal cancer surgery influences patients' health-related quality of life (HRQOL).

SETTING

This was a nationwide Swedish population-based study.

PARTICIPANTS

A total of 616 patients who underwent curatively intended oesophageal cancer surgery in 2001-2005 were followed up at 6 months and 5 years after surgery.

OUTCOME MEASURES

HRQOL was assessed with the validated European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (EORTC QLQ-C30) and the oesophageal cancer-specific module (EORTC QLQ-OES18). The number of removed lymph nodes in relation to HRQOL was analysed using multivariable linear regression, providing mean score differences in HRQOL scores with 95% CIs. The results were adjusted for age, comorbidity, body mass index, tumour stage, tumour histology, postoperative complications and surgeon volume.

RESULTS

The study included 382 and 136 patients who completed the EORTC questionnaires at 6 months and 5 years following surgery, respectively. In general, HRQOL remained stable over time, with only improvements in role function and appetite loss. A larger number of removed lymph nodes did not decrease the HRQOL measure at 6 months or 5 years after surgery.

CONCLUSIONS

More extensive lymphadenectomy during oesophageal cancer surgery might not decrease patients' short-term or long-term HRQOL, but larger studies are needed to establish this potential lack of association.

Cancer survivorship: long-term side-effects of anticancer treatments of gastrointestinal cancer

PURPOSE OF REVIEW

Surveillance of patients with a history of cancer is a frequent practice in oncology. However, it is often aimed at the early diagnosis of relapse and tends to underestimate the evaluation and care of factors impairing quality of life (QoL). Among these, long-term toxicities of anticancer treatments are one of the major threats to a complete physical and psychosocial recovery. We aimed to review the relevant literature on long-term side-effects of treatment in gastrointestinal cancers.

RECENT FINDINGS

We focused on esophageal, gastric, pancreatic, liver and colorectal cancers. A significant fraction of patients treated for these cancers suffer with some form of late toxicity from surgery, radiotherapy or chemotherapy. Prompt evaluation and management is of the utmost importance in reducing the impact of these symptoms on QoL.

SUMMARY

The knowledge of the reviewed data should encourage a multidisciplinary approach to surveillance and convince clinicians of the comprehensive role of survivorship care.

Does the site of anastomosis for esophagectomy affect long-term quality of life?

Long-term survival after esophagectomy is improving, and hence, quality of life (QOL) of these patients has become a priority. There has been extensive debate regarding the optimal site of surgical anastomosis (cervical or intrathoracic). We aimed to evaluate the impact of anastomotic site on long-term QOL postesophagectomy. Quality of life questionnaires (European Organisation for Research and Treatment of Cancer [EORTC] C-30 and OG-25) were sent to patients surviving over 3 years following esophagectomy. The data were analyzed by site of esophagogastric anastomosis: intrathoracic or cervical. EORTC C-30 data were compared against the reference population data. Of the patients, 62 responded (82%) with a median time postsurgery of 6.1 years (range 3-12 years). Patient demographics were comparable. There was no significant difference between cervical or intrathoracic anastomosis groups for functional or symptom scores, focusing on dysphagia (cervical = 8.8 vs. intrathoracic = 17.6, P = 0.24), odynophagia (cervical = 13.4 vs. intrathoracic = 16.1, P = 0.68) and swallowing problems (cervical = 8.1 vs. intrathoracic = 13.4, P = 0.32). There was no difference in overall health score between groups (cervical = 70.5 vs. intrathoracic = 71.6, P = 0.46). Overall general health score was comparable with the reference population (esophagectomy group P = 70.9 ± 22.1 vs. reference population = 71.2 ± 22.4, P = 0.93). There is no difference in long-term QOL after esophagectomy between patients with a cervical or intrathoracic anastomosis. Scores compare favorably with EORTC reference data. Survival after esophagectomy is associated with recovery of QOL in the long term, regardless of site of anastomosis and despite worse gastrointestinal-related symptoms.

Long-term quality of life after surgery for adenocarcinoma of the esophagogastric junction: extended gastrectomy or transthoracic esophagectomy?

BACKGROUND

Esophagectomy with gastric tube reconstruction and extended transhiatal gastrectomy with Roux-en-Y reconstruction are alternative procedures in current therapeutic concepts for adenocarcinoma of the esophagogastric junction (AEG). The impact of these operations on long-term health-related quality of life (HRQL) is incompletely understood.

METHODS

Patients with cancer-free survival of at least 24 months after esophagectomy (ESO) or extended gastrectomy (GAST) for AEG were identified from a prospectively maintained database. EORTC questionnaires were sent out to assess health-related general (QLQ-C30) and cancer-specific (OG-25) quality of life. Numeric scores were calculated for each conceptual area and compared with those of healthy reference populations.

RESULTS

123 patients (ESO n = 71; GAST n = 52) completed the self-rated questionnaires. HRQL was consistently lower in surgical patients (GAST and ESO) compared with healthy reference populations. Also, there was a general trend for a better HRQL in GAST compared with ESO patients. This trend was statistically significant for physical function (p = 0.04), dyspnea (p = 0.02), and reflux (p = 0.03). Subgroup analysis revealed no significant differences between patients with or without prior neoadjuvant therapy.

CONCLUSIONS

After mid- and long-term follow-up, HRQL after extended gastrectomy with Roux-en-Y reconstruction is superior to that after esophagectomy and gastric tube reconstruction. Improved HRQL after gastrectomy is mainly due to less pulmonary and reflux-related symptoms. Our findings may influence the choice of the surgical strategy for patients with AEG.

Assessing the quality of written information provision for surgical procedures: a case study in oesophagectomy

OBJECTIVE

To examine the content and quality of written information provided by surgical centres for patients undergoing oesophagectomy for cancer.

DESIGN

Cross-sectional study of the content of National Health Service (NHS) patient information leaflets (PILs) about oesophageal cancer surgery, using a modified framework approach.

DATA SOURCES

Written information leaflets from 41 of 43 cancer centres undertaking surgery for oesophageal cancer in England and Wales (response rate 95.3%).

ELIGIBILITY CRITERIA

All English language versions of PILs about oesophagectomy.

RESULTS

32 different PILs were identified, of which 2 were generic tools (Macmillan 'understanding cancer of the gullet' and EIDO 'oesophagectomy'). Although most PILs focused on describing in-hospital adverse events, information varied widely and was often misleading. Just 1 leaflet described survival benefits of surgery and 2 mentioned the possibility of disease recurrence.

CONCLUSIONS

Written information provided for patients by NHS cancer centres undertaking oesophagectomy is inconsistent and incomplete. It is recommended that surgeons work together with patients to agree on standards of information provision of relevance to all stakeholders' needs.

Health-related quality of life and hospital costs following esophageal resection: a prospective cohort study

BACKGROUND

The incidence rates for adenocarcinoma of the esophagus are increasing while the prognosis has only improved slightly. There is no apparent benefit in short- and long-term survival after different surgical strategies, but surgery is associated with significant morbidity. The goal of this study is to prospectively assess the quality of life and hospital costs after esophageal resections depending on the development of complications.

METHODS

Prospective data was collected from 47 patients undergoing an esophageal resection for esophageal cancer participating in the prospective LAParotomy or LAParoscopy and Adhesions (LAPAD) study (clinicaltrials.gov registration number: NCT01236625). A comparison was made between patients who developed major complications and minor or no complications regarding quality of life and hospital costs.

RESULTS

Thirteen patients developed major complications while 34 patients developed only minor or no complications. Patients with major complications had a mean hospital cost of $16,369 vs $12,409 for patients without or with minor complications. We found no difference in quality of life between the two groups 6 months after surgery.

CONCLUSIONS

In our cohort, major complications did not seem to have a detrimental effect on postoperative quality of life 6 months after surgery but they increased costs associated with esophageal resection.

Long-term quality of life after oesophagectomy with gastric conduit interposition for cancer

BACKGROUND

Gaining insight in long-term health-related quality of life more than 1year after oesophagectomy will assist clinical decision-making and inform patients about the long-term consequences of surgery.

METHODS

In this cross-sectional study, all consecutive patients who underwent oesophageal resection with gastric interposition for cancer at a tertiary referral centre between January 2007 and July 2012 were included. European Organization for Research and Treatment of Cancer (EORTC) quality of life questionnaire (QLQ)-C30 and QLQ-OES18 were sent to all patients alive without recurrence more than 1year after surgery.

RESULTS

The questionnaires were completed by 92 of 100 patients. Median duration of follow-up after surgery at completing the questionnaire was 36months (range: 12-75). Global quality of life scores were similar to a general population reference group (76±19 versus 78±17; p=0.26). However, patients scored significantly worse compared to the general population reference group on physical-, role-, cognitive- and social functioning (p<0.001). Neoadjuvant therapy and minimally invasive oesophagectomy were associated with significantly better health-related quality of life (HRQL) and symptom scores (p<0.05).

CONCLUSION

Global HRQL more than 1year after oesophagectomy with gastric tube reconstruction is comparable to the general Dutch background population, while specific functional and symptom scores are significantly worse. Neoadjuvant therapy and minimally invasive surgery are associated with quality of life benefits in long-term survivors.

Quality of life measurements as an indicator for timing of support after oesophagectomy for cancer: a prospective study

Background

Oesophagectomy is a major procedure with known side effects and reduced postoperative quality of life (QOL). It has been shown that support of patients in their new life situation is often lacking. Knowledge about how QOL changes over time is fundamental for addressing patient needs and for determining the optimal timing of supportive care. The aim of this study was to identify QOL changes over time as well as factors that may impact patient QOL during the first year after oesophagectomy for cancer.

Methods

Patients operated on for adenocarcinoma or squamous cell cancer of the oesophagus were included in this study. Seventy-nine patients completed the European Organisation for Research and Treatment of Cancer QOL questionnaires (QLQ-C30 and QLQ-OES18) before and 2, 4, 6, 9, and 12 months after surgery. A general linear model with repeated measurement analysis of variance was used for statistical testing.

Results

There was a significant QOL nadir at 2 months compared to 12 months after surgery (QLQ-C30 function scales p < 0.001, symptom scales p < 0.001, QLQ-OES18 scales p < 0.001). Treatment with proton-pump inhibitors was associated with enhanced QOL according to QLQ-C30 symptom scales (p = 0.003) and OES-18 scales (p = 0.015), but age, gender and American Society of Anaesthesiologists classification did not significantly impact QOL.

Conclusions

Patient QOL is severely hampered the first year after oesophagectomy for cancer, with a nadir at 2 months after surgery. Treatment with proton-pump inhibitors improved patient responses to symptom scales. Evidence of severely affected QOL after surgery indicates that these patients need support at an early stage after surgery. These results can be used by healthcare professionals to develop a postoperative supportive-care programme that is timed and better optimised to meet patient needs. Trial registration: EudraCT database 2009-009997-28.

Dietary alterations and restrictions following surgery for upper gastrointestinal cancers: Key components of a health-related quality of life intervention

PURPOSE

The surgical treatment of upper gastrointestinal (GI) cancers, specifically esophageal and gastric cancers, often result in extensive health-related quality of life (HRQOL) concerns, particularly those associated with dietary adjustments. This paper provides a review of HRQOL changes following esophagectomy and gastrectomy, and describes key components of an intervention to improve dietary adjustments following surgery.

METHODS

Intervention development was informed by 1) current published evidence on HRQOL changes for patients following upper GI surgery, 2) examination of usual post-operative care related to dietary restrictions to identify areas for continued education and support and 3) the inclusion of a conceptual framework (the Chronic Care Model) to guide intervention design and inform the selection of appropriate outcome measures.

RESULTS

Three key components of an HRQOL intervention are identified, and should focus on HRQOL concerns associated with dietary alterations and restrictions following treatment, involve family caregivers, and be tailored and flexible to patient and family caregiver's needs and preferences.

CONCLUSIONS

Evidence-based interventions to support long-term dietary alterations and restrictions following upper GI surgery are lacking, despite evidence confirming its impact on morbidity and mortality. Interventions are needed to support dietary adjustments, prevent malnutrition and excessive weight loss, and enhance HRQOL following surgery for upper GI cancers.

Quality of life for patients with esophageal/gastric cardia precursor lesions or cancer: a one-year prospective study

BACKGROUND

The current study examined health-related quality of life (QoL) for patients with esophageal/ gastric cardia precursor lesions or cancer before and after treatment to facilitate improved prevention and treatment.

MATERIALS AND METHODS

Patients with different stages of esophageal/gastric cardia lesions completed two QoL questionnaires, EORTC QLQ-C30 and supplemental QLQ-OES 18, before primary treatment, and at 1, 6 and 12 months after treatment.

RESULTS

Fifty-nine patients with precursor lesions, 57 with early stage cancer, and 43 with advanced cancer responded to our survey. Patients with precursor lesions or early stage cancer reported better QoL overall than those with advanced cancer before treatment (p<0.01). Global QoL scores before treatment and at 1 month after treatment were 71±9 versus 69±9 (p>0.01), 71±8 versus 61±11 (p<0.01), 67 ± 11 versus 62 ± 9 (p<0.01) for three stages of lesions. At 6 months after treatment, some QoL measures recovered gradually in precursor lesion and early cancer patients, while some continuously deteriorated in advanced cancer patients. At 12 months, all QoL scores were comparable to baseline for patients with precursor lesions (p>0.01), while global QoL, social, pain, and insomnia scores for early stage and advanced cancer were inferior to corresponding baseline levels (difference between means>5, p<0.01). At this time point, compared with patients with early stage cancer, those with advanced cancer showed worse QoL with all function and most symptom measures (p<0.01).

CONCLUSIONS

Patients with precursor lesions or early stage esophageal/gastric cardia cancer show better QoL than those with advanced cancer. This indicates that screening, early diagnosis and treatment may improve the QoL for esophageal/gastric cardia cancer patients. Target intervention and counseling should be given by health care providers during treatment and follow-up to facilitate QoL improvement.

Quality of life after surgical treatment of early Barrett's cancer: a prospective comparison of the Ivor-Lewis resection versus the modified Merendino resection

INTRODUCTION

The Merendino (MER) procedure has been evaluated as an alternative to transthoracic esophageal resection (TER) for early stage Barrett's carcinoma. Apart from reducing morbidity and mortality, improvements concerning postoperative health-related quality of life (HRQL) have been postulated. The aim of our study was to compare HRQL between these procedures.

MATERIALS AND METHODS

Between July 2000 and July 2007, 117 patients with early Barrett's carcinoma underwent surgery. Patients with tumor recurrence were excluded from the study. HRQL was assessed 1 and 2 years after surgery using the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Core Questionnaire (EORTC-QLQ-C30) and the QLQ-OES18 module. Patients recently diagnosed with early Barrett's carcinoma served as controls. Symptoms that showed a difference of more than ten between the control and the study groups were considered clinically relevant and were tested for significant differences between the study groups using the Mann-Whitney U test (p < 0.05).

RESULTS

The response rates for the questionnaires ranged between 70 and 93 %. In the MER group, more items reflected a clinical relevant impairment of HRQL than in the TER group. Significant complaints in the MER group included nausea/vomiting, appetite loss, local pain, difficulties with social eating, and choking. Moreover, we found a significant restriction concerning global health and emotional and social functioning in this group 1 year after surgery. 2 years postoperatively, hardly any differences between the operative techniques could be detected. The only symptom in favor of the MER procedure was a better dysphagia score postoperatively.

CONCLUSION

Our study suggests that MER procedure is not superior to subtotal esophagectomy with regard to HRQL.

Comparison of the health-related quality of life in patients with narrow gastric tube and whole stomach reconstruction after oncologic esophagectomy: a prospective randomized study

BACKGROUND AND AIMS

To compare the health-related quality of life in patients with narrow gastric tube and whole stomach reconstructions after oncologic esophagectomy.

MATERIAL AND METHODS

In a prospective randomized single-center study from 2007 to 2008, 104 patients underwent esophagectomy for cancer. To assess health-related quality of life, the questionnaire (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 and the Oesophagus-Specific Quality of Life Questionnaire 18) was administered at 3 weeks, 6 months, 1 year, and 2 years after surgery.

RESULTS

The perioperative complication rate was 26.9% in narrow gastric tube group and 48.1% in whole stomach group (P = 0.31). At the time of 3 weeks after surgery, the reflux and dyspnea scores were higher in whole stomach group than in narrow gastric tube group, which meant that the patients in whole stomach group suffered more severe problem. At the time of 6 months and 1 year after surgery, the reflux scores were lower in narrow gastric tube group than in whole stomach group, which revealed that there were less problems of reflux in the patients of narrow gastric tube group; meanwhile, the score of physical function scale in narrow gastric tube group was higher conversely, which suggested that the patients gain a better status in physical function. Nausea and vomiting is the only notable symptom that was worse in whole stomach group at the time of 2 years after surgery, which suggested that patients in whole stomach group suffered more severe nausea and vomiting.

CONCLUSIONS

Narrow gastric tube reconstruction may be a good alternative choice for patients undergoing oncologic esophagectomy in view of better health-related quality of life after the surgery.

Predicting blood transfusion in patients undergoing minimally invasive oesophagectomy

AIM

To evaluate predictors of allogenic blood transfusion requirements in patients undergoing minimal invasive oesophagectomy at a tertiary high volume centre for oesophago-gastric surgery.

METHODS

Retrospective analysis of all patients undergoing minimal access oesophagectomy in our department between January 2010 and December 2011. Patients were divided into two groups depending on whether they required a blood transfusion at any time during their index admission. Factors that have been shown to influence perioperative blood transfusion requirements in major surgery were included in the analysis. Binary logistic regression analysis was performed to determine the impact of patient and perioperative characteristics on transfusion requirements during the index admission.

RESULTS

A total of 80 patients underwent minimal access oesophagectomy, of which 61 patients had a laparoscopic assisted oesophagectomy and 19 patients had a minimal invasive oesophagectomy. Perioperative blood transfusion was required in 28 patients at any time during hospital admission. On binary logistic regression analysis, a lower preoperative haemoglobin concentration (p < 0.01), suffering a significant complication (p < 0.005) and laparoscopic assisted oesophagectomy (p < 0.05) were independent predictors of blood transfusion requirements.

DISCUSSION

It has been reported that requirement for blood transfusion can affect long-term outcomes in oesophageal cancer resection. Two factors which could be addressed preoperatively; haemoglobin concentration and type of oesophageal resection, may be valuable in predicting blood transfusions in patients undergoing minimally invasive oesophagectomy.

CONCLUSION

Our analysis revealed that preoperative haemoglobin concentration, occurrence of significant complications and type of minimal access oesophagectomy predicted blood transfusion requirements in the patient population examined.

Long-term quality of life and alimentary satisfaction after esophagectomy with colon interposition

BACKGROUND

The long-term outcome after colon interposition for esophageal reconstruction is not well documented. Our objective was to assess quality of life and alimentary satisfaction 10 or more years after colon interposition.

METHODS

Patients who had an esophagectomy that was reconstructed using a colon interposition before April 2003 were identified. Symptoms, alimentary satisfaction, and quality of life were assessed by telephone interview and questionnaires.

RESULTS

We identified 79 surviving patients, and follow-up was obtained in 63 (80%). The indication for esophagectomy was cancer in 45 patients and benign disease in 18. Vagal-sparing esophagectomy was performed in 48% of patients, en bloc in 44%, and transhiatal in 8%. Median follow-up was 13 years (range, 10 to 38 years). The median Gastrointestinal Quality of Life Index score was 3 of 4 and results from the RAND 36-Item Short Form Health Survey (RAND Corp, Santa Monica, CA) were at or above the published normal means in all categories. Most patients were free of dysphagia (89%), regurgitation (84%), and heartburn (84%). The most common postprandial symptom was early satiety (40%). The body mass index was within normal reference ranges in 90% of patients. Follow-up esophagogastroduodenoscopy in 30 patients at a median of 6 years showed no Barrett's metaplasia in the residual esophagus. Seven patients had a reoperation for colon redundancy.

CONCLUSIONS

Long-term alimentary satisfaction and quality of life were excellent after colon interposition. Most patients were free of dysphagia and few needed revision for redundancy. These results should encourage the use of a colon interposition in patients expected to survive long-term after esophagectomy.

Quality of life in patients with esophageal cancer receiving definitive chemoradiotherapy or esophagectomy

The aim of the present study was to assess the variation in the quality of life (QOL) of patients with esophageal cancer receiving definitive chemoradiotherapy or esophagectomy, and to explore the main factors that affects QOL. A total of 102 patients with esophageal cancer receiving definitive chemoradiotherapy or esophagectomy were assessed using a QOL questionnaire, and a numeric score was calculated in each conceptual area and compared with reference data by a statistical method. With regards to the impacts on the QOL, the chemoradiotherapy had less of an impact compared with esophagectomy. The QOL declined following the two treatments, but was restored in a specific period of time. In the present study, the main factors that affected the QOL of patients included physical function, fatigue and pain. Definitive chemoradiotherapy is therefore superior to esophagectomy with regard to its effect on the QOL. The two treatments had an effect on the QOL of patients, but this effect was temporary and was resumed after a period of time.

Aspects of emotional functioning following oesophageal cancer surgery in a population-based cohort study

OBJECTIVE

The aim of this study was to establish the proportion of patients reporting emotional problems following oesophagectomy for cancer and identify the risk characteristics for emotional problems.

METHODS

A Swedish population-based cohort study of patients with surgically treated oesophageal cancer was used. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 was used to assess tension, worry, irritation and depressed mood at 6 months and 5 years after surgery. Potential risk characteristics were retrieved from medical notes and data linkages to Swedish health registries. Multivariable logistic regression analyses were performed to examine risk characteristics for poor emotional recovery.

RESULTS

Of 401 patients included at 6 months, 49% reported problems with tension, 61% worry, 62% irritation and 63% depressed mood. Of the 140 (35%) patients who completed the 5-year follow-up, 39% reported problems with tension and about half of the patients reported problems with worry, irritation, and depressed mood (49, 45 and 52%, respectively). Squamous cell carcinoma was identified as a risk characteristic for tension (OR 2.15, 95% CI 1.30-3.55), worry (OR 2.02, 95% CI 1.19-3.40) and depressed mood (OR 1.71, 95% CI 1.01-2.90) at 6 months compared with adenocarcinoma. Compared with higher education, lower education was associated with tension (upper secondary schooling: OR 1.97, 95% CI 1.02-3.79 and 9-year compulsory: OR 2.46, 95% CI 1.28-4.74), while non-cohabitating patients were less likely to report problems with worry at 6 months (OR 0.53, 95% CI 0.34-0.84) compared with cohabitating patients.

CONCLUSIONS

A substantial proportion of patients reports emotional problems following oesophagectomy, and risk characteristics include squamous cell carcinoma histology and low educational level.