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Huang Y, Xie Q, Wei X, Shi Q, Zhou Q, Leng X, Miao Y, Han Y, Wang K, Fang Q. Enhanced Recovery Protocol Versus Conventional Care in Patients Undergoing Esophagectomy for Cancer: Advantages in Clinical and Patient-Reported Outcomes. Ann Surg Oncol 2024; 31:5706-5716. [PMID: 38833056 DOI: 10.1245/s10434-024-15509-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 05/09/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND This study was designed to compare the clinical and patient-reported outcomes (PROs) between the enhanced recovery after surgery (ERAS) protocol and conventional care in patients undergoing esophagectomy for cancer, which have not previously been compared. METHODS This single-center retrospective study included prospective PRO data from August 2019 to June 2021. Clinical outcomes included perioperative complications and postoperative length of stay (PLOS). Patient-reported outcomes were assessed by using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (QLQ-C30) and esophagus-specific module (QLQ-OES18) preoperatively to 6 months postoperatively. Mixed-effects models were used to longitudinally compare quality of life (QOL) scores between the two modes. RESULTS Patients undergoing conventional care and ERAS were analyzed (n = 348 and 109, respectively). The ERAS group had fewer overall complications, pneumonia, arrhythmia, and a shorter PLOS than the conventional group, and outperformed the conventional group in five functional QLQ-C30 domains and five symptom QLQ-OES18 domains, including less dysphagia (p < 0.0001), trouble talking (p = 0.0006), and better eating (p < 0.0001). These advantages persisted for 3 months postoperatively. For the cervical circular stapled anastomosis, the initial domains and duration of benefit were reduced in the ERAS group. CONCLUSIONS The ERAS protocol has significant advantages over conventional care in terms of clinical outcomes, lowering postoperative symptom burden, and improving functional QOL in patients who have undergone esophagectomy. Selection of the optimal technique for cervical anastomosis is a key operative component of ERAS that maintains the symptom domains and duration of the advantages of PROs.
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Affiliation(s)
- Yixuan Huang
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of the University of Electronic Science and Technology of China, Chengdu, China
| | - Qin Xie
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of the University of Electronic Science and Technology of China, Chengdu, China
| | - Xing Wei
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of the University of Electronic Science and Technology of China, Chengdu, China
| | - Qiuling Shi
- School of Public Health, Chongqing Medical University, Chongqing, China
| | - Qiang Zhou
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of the University of Electronic Science and Technology of China, Chengdu, China
| | - Xuefeng Leng
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of the University of Electronic Science and Technology of China, Chengdu, China
| | - Yan Miao
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of the University of Electronic Science and Technology of China, Chengdu, China
| | - Yongtao Han
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of the University of Electronic Science and Technology of China, Chengdu, China
| | - Kangning Wang
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of the University of Electronic Science and Technology of China, Chengdu, China.
| | - Qiang Fang
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of the University of Electronic Science and Technology of China, Chengdu, China.
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Shiomi S, Okumura Y, Nakane K, Toriumi T, Kawasaki K, Yajima S, Yagi K, Nomura S, Seto Y. Percent vital capacity predicts postoperative sarcopenia after esophagectomy in initially nonsarcopenic esophageal cancer patients: a retrospective cohort study. Surg Today 2024; 54:702-711. [PMID: 38227021 DOI: 10.1007/s00595-023-02788-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 10/25/2023] [Indexed: 01/17/2024]
Abstract
PURPOSE The development of sarcopenia after esophagectomy is reported to affect the outcomes of patients with esophageal cancer (EC); however, the characteristics of patients likely to be predisposed to postoperative sarcopenia have not been defined. This study explores the associations between preoperative respiratory function and surgery-induced sarcopenia in EC patients confirmed as nonsarcopenic preoperatively. METHODS The subjects of this retrospective review were 128 nonsarcopenic patients who underwent esophagectomy for EC. We took body composition measurements and performed physical function tests 3 and 6 months postoperatively, to establish whether sarcopenia was present, according to the 2019 Asian Working Group for Sarcopenia guideline. We defined patients with surgery-induced sarcopenia as those with evidence of the development of sarcopenia within 6 months postoperatively or those with documented sarcopenia at 3 months but who could not be evaluated at 6 months. RESULTS Surgery-induced sarcopenia developed in 19 of the 128 patients (14.8%), which correlated significantly with the preoperative %VC value (p < 0.01), but not with the preoperative FEV1.0% value. We set the lower quartile %VC value (91%) as the cut-off for predicting surgery-induced sarcopenia. A low %VC was independently associated with surgery-induced sarcopenia (odds ratio: 5.74; 95% confidence interval: 1.99-16.57; p < 0.01). CONCLUSIONS Based on the findings of this study, %VC was a simple but valuable factor for predicting sarcopenia induced by esophagectomy.
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Affiliation(s)
- Shinichiro Shiomi
- Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Yasuhiro Okumura
- Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan.
| | - Kosuke Nakane
- Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Tetsuro Toriumi
- Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka-Shi, Saitama, 350-1298, Japan
| | - Koichiro Kawasaki
- Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
- Department of Surgery, Tokyo Metropolitan Bokutou Hospital, 4-23-15 Kotobashi, Sumida-Ku, Tokyo, 130-8575, Japan
| | - Shoh Yajima
- Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Koichi Yagi
- Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Sachiyo Nomura
- Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Yasuyuki Seto
- Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
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Wu TC, Farrell MJ, Karimi-Mostowfi N, Chaballout BH, Akingbemi WO, Grogan TR, Raldow AC. Evaluating the Impact of Race and Ethnicity on Health-Related Quality of Life Disparities in Patients with Esophageal Cancer: A SEER-MHOS National Database Study. Cancer Epidemiol Biomarkers Prev 2024; 33:254-260. [PMID: 38015776 DOI: 10.1158/1055-9965.epi-23-0789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 09/15/2023] [Accepted: 11/21/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND It is unclear whether health-related quality of life (HRQOL) disparities exist between racial/ethnic groups in older patients with esophageal cancer, pre- and post-diagnosis. METHODS Using the SEER-MHOS (Surveillance, Epidemiology, and End Results and Medicare Health Outcomes Survey) national database, we included patients ages 65-years-old or greater with esophageal cancer diagnosed from 1996 to 2017. HRQOL data within 36 months before and after diagnosis were measured by the Physical Component Summary (PCS) and Mental Component Summary (MCS) scores from the SF-36 and VR-12 instruments. Total combined score (TCS) was reflected by both PCS and MCS. RESULTS We identified 1,312 patients, with evaluable data on 873 patients pre-diagnosis and 439 post-diagnosis. On pre-diagnosis cohort MVA, the MCS was better for White over Hispanic patients (54.1 vs. 48.6, P = 0.012). On post-diagnosis cohort MVA, PCS was better for Hispanic compared with White (39.8 vs. 34.5, P = 0.036) patients, MCS was better for Asian compared with White (48.9 vs. 40.9, P = 0.034) patients, and TCS better for Asian compared with White (92.6 vs. 76.7, P = 0.003) patients. CONCLUSIONS In older patients with esophageal cancer, White patients had better mental HRQOL as compared with Hispanic patients pre-diagnosis. However, post-diagnosis, White patients had worse mental and physical HRQOL compared with Asian and Hispanic patients, respectively, suggesting a greater negative impact on self-reported HRQOL in White patients with esophageal cancer. IMPACT To our knowledge, this study is the first to explore HRQOL differences in patients with esophageal cancer of various racial and ethnic groups and warrants further validation in future studies.
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Affiliation(s)
- Trudy C Wu
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California
| | - Matthew J Farrell
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California
| | | | - Basil H Chaballout
- University of South Carolina, School of Medicine Greenville, Greenville, South Carolina
| | | | - Tristan R Grogan
- Department of Medicine Statistics Core, University of California Los Angeles, Los Angeles, California
| | - Ann C Raldow
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California
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Seo A, Chang AY. A systematic review of the social impact of diseases in Nordic countries. Scand J Public Health 2024:14034948231217365. [PMID: 38166481 DOI: 10.1177/14034948231217365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
BACKGROUND We review the literature on the social impacts of diseases, defined as the social consequences of having a disease on the people around the patient, such as spouses, caregivers and offspring. The two objectives of this study are to summarise the social outcomes commonly associated with diseases and to compare the social impact across a range of diseases. METHODS A systematic review of the social impact of disease in Nordic countries was conducted using PubMed, PsycINFO and Google Scholar (PROSPERO registration number CRD42022291796). All articles that met the inclusion criteria were reviewed. We tabulated all outcomes and diseases studied, and synthesised the evidence based on the perspectives of patients, spouse/caregiver and offspring. RESULTS A total of 135 studies met the eligibility criteria, covering 76 diseases and 39 outcomes. From the patient's perspective, diseases impact divorce and marriage rates, social functioning, likelihood of committing a crime and being a victim of crime. From the caregiver's perspective, diseases affect their health-related quality of life and physical and psychological health. From the offspring's perspective, diseases impact their development, health and social adversities in later life. Diseases generally had negative social impacts, but there were some diseases associated with positive impacts. CONCLUSIONS The review provides a useful summary and gross comparison of the social impact of different diseases. The social impact of diseases can be large and significant. Thus, it should be considered when policymakers are setting priorities across disease areas.
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Affiliation(s)
- Ahreum Seo
- Department of Public Health, University of Southern Denmark, Denmark
| | - Angela Y Chang
- Danish Institute for Advanced Study, University of Southern Denmark, Denmark
- Department of Clinical Research, University of Southern Denmark, Denmark
- Interdisciplinary Centre on Population Dynamics (CPop), University of Southern Denmark, Denmark
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Wang YJ, He XD, He YQ, Bao T, Xie XF, Li KK, Guo W. Comparison of two different methods for lymphadenectomy along the left recurrent laryngeal nerve by minimally invasive esophagectomy in patients with esophageal squamous cell carcinoma: a prospective randomized trial. Int J Surg 2024; 110:159-166. [PMID: 37737902 PMCID: PMC10793764 DOI: 10.1097/js9.0000000000000788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/10/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Lymph nodes along the left recurrent laryngeal nerve (LRLN) is thought to be highly involved in esophageal cancer. Given the unique anatomical positioning of the nerve, performing lymphadenectomy in this region requires advanced techniques within limited working space. Meanwhile, high incidence of morbidity and mortality is associated with lymphadenectomy. Although several methods have been applied to reduce the technical requirement and the incidence of postoperative complication, the optimal method remains controversial. METHODS This study was a single-center, prospective, randomized trial to investigate the utility of lymphadenectomy along the LRLN during the minimally invasive esophagectomy in esophageal squamous cell carcinoma patients by comparing the surgical outcome, postoperative complication, survival rate, and quality of life (QoL) between the retraction method (RM) and the suspension method (SM) in patients with esophageal cancer from June 2018 to November 2020. QoL was assessed according to questionnaire: EQ-5D-5L. RESULTS Of 94 patients were enrolled and randomized allocated to RM and SM group equally. Characteristics did not differ between groups. The duration of lymph node dissection along LRLN was significant longer in SM group ( P <0.001). No difference was observed about postoperative complications. One of in-hospital death was occurred in each group ( P >0.999). Patients in neither of groups exhibiting difference about 3-year disease-free survival rate ( P =0.180) and overall survival rate ( P =0.430). No difference was observed in postoperative QoL between groups at different time points (all, P >0.05). CONCLUSION Both methods of lymph node dissection along the LRLN during minimally invasive esophagectomy in esophageal squamous cell carcinoma patients are technically feasible and safe. The RM appears more favorable in terms of reducing surgical duration compared to the SM.
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Affiliation(s)
- Ying-Jian Wang
- Department of Thoracic Surgery, Army Medical Center of PLA (Daping Hospital), Daping
| | - Xian-Dong He
- Department of Thoracic Surgery, Army Medical Center of PLA (Daping Hospital), Daping
| | - Yi-Qiu He
- Department of Pediatrics, Shapingba District Maternity and Infant Health Hospital, Shapingba, Choingqing, People’s Republic of China
| | - Tao Bao
- Department of Thoracic Surgery, Army Medical Center of PLA (Daping Hospital), Daping
| | - Xian-Feng Xie
- Department of Thoracic Surgery, Army Medical Center of PLA (Daping Hospital), Daping
| | - Kun-Kun Li
- Department of Thoracic Surgery, Army Medical Center of PLA (Daping Hospital), Daping
| | - Wei Guo
- Department of Thoracic Surgery, Army Medical Center of PLA (Daping Hospital), Daping
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van Erning FN, Nieuwenhuijzen GAP, van Laarhoven HWM, Rosman C, Gisbertz SS, Heisterkamp J, Lagarde SM, Slingerland M, van den Berg JW, Kouwenhoven EA, Verhoeven RHA, Vissers PAJ. Gastrointestinal Symptoms After Resection of Esophagogastric Cancer: A Longitudinal Study on Their Incidence and Impact on Patient-Reported Outcomes. Ann Surg Oncol 2023; 30:8203-8215. [PMID: 37523120 DOI: 10.1245/s10434-023-13952-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/19/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND This study assesses the incidence of gastrointestinal symptoms in the first year after resection of esophageal or gastric cancer and its association with health-related quality of life (HRQoL), functioning, work productivity, and daily activities. PATIENTS AND METHODS Patients diagnosed with esophageal or gastric cancer between 2015 and 2021, who underwent a resection, and completed ≥ 2 questionnaires from the time intervals prior to resection and 0-3, 3-6, 6-9, and 9-12 months after resection were included. Multivariable generalized linear mixed models were used to assess changes in gastrointestinal symptoms over time and the impact of the number of gastrointestinal symptoms on HRQoL, functioning, work productivity, and daily activities for patients who underwent an esophagectomy or gastrectomy separately. RESULTS The study population consisted of 961 (78.8%) and 259 (21.2%) patients who underwent an esophagectomy and gastrectomy, respectively. For both groups, the majority of gastrointestinal symptoms changed significantly over time. Most clinically relevant differences were observed 0-3 after resection compared with prior to resection and included increased diarrhea, appetite loss, and eating restrictions, and specifically after esophagectomy dry mouth, trouble with coughing, and trouble talking. At 9-12 after resection one or more severe gastrointestinal symptoms were reported by 38.9% after esophagectomy and 33.7% after gastrectomy. A higher number of gastrointestinal symptoms was associated with poorer functioning, lower HRQoL, higher impairment in daily activities, and lower work productivity. CONCLUSIONS This study shows that gastrointestinal symptoms are frequently observed and burdensome after esophagectomy or gastrectomy, highlighting the importance to address these sequelae for high quality survivorship.
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Affiliation(s)
- Felice N van Erning
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands.
| | | | - Hanneke W M van Laarhoven
- Department of Medical Oncology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Camiel Rosman
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Suzanne S Gisbertz
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
| | - Joos Heisterkamp
- Department of Surgery, Elisabeth Tweesteden Hospital, Tilburg, The Netherlands
| | - Sjoerd M Lagarde
- Department of Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marije Slingerland
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan-Willem van den Berg
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | - Rob H A Verhoeven
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
- Department of Medical Oncology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
| | - Pauline A J Vissers
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
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Adanur Uzunlar E. Nutritional Problems Related to Oropharyngeal and Esophageal Changes in Aging: A Narrative Review. JOURNAL OF THE AMERICAN NUTRITION ASSOCIATION 2023; 42:790-797. [PMID: 36847777 DOI: 10.1080/27697061.2023.2179553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 02/07/2023] [Indexed: 03/01/2023]
Abstract
Today, it is known that the elderly population is increasing rapidly with the quality of life. The United Nations estimate that one in six people will be 65 years or older by 2050. This situation causes interest in the old age period to increase day by day. In parallel with this, studies on the aging process have grown rapidly. Especially the health problems accompanying extended life expectancy and its treatment have become the focus of researchers in recent years. It is a known fact that some sensory and physiological changes in old age affect the quality of oral food intake and food taste. This may lead to inadequate nutritional intake and even rejection of food intake in the elderly. Therefore, severe malnutrition and sarcopenia occur in these individuals, and their life span is shortened. In this review, the effects of aging-related oropharyngeal and esophageal changes and problems on oral food intake will be evaluated. Our increasing knowledge on this subject will contribute to healthcare professionals in the prevention and treatment of health problems such as malnutrition that may occur during the aging process. In this review, a literature search was conducted with the keywords "older" or "elderly" or "geriatrics" and "nutrition" or "malnutrition" and "oropharyngeal functions" or "esophageal functions" in PubMed, ScienceDirect, and Google Scholar electronic databases. KEY TEACHING POINTSSome changes may occur in oropharyngeal and esophageal functions with aging.Sensory and physiological changes in the aging process affect oral food intake and nutritional status.Impairments in oral food intake in elderly individuals can lead to malnutrition and sarcopenia.Age-related changes affecting oral food intake increase the importance of nutritionists with the increase in the elderly population.
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Affiliation(s)
- Elif Adanur Uzunlar
- Faculty of Health Sciences, Department of Nutrition and Dietetics, Karadeniz Technical University, Trabzon, Turkey
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8
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Jia S, Chen Y, Cui J, Wang T, Lin CC. Relationship of weight loss to quality of life and symptom distress among postsurgical survivors of oesophageal cancer who received chemotherapy. Eur J Oncol Nurs 2023; 66:102370. [PMID: 37490815 DOI: 10.1016/j.ejon.2023.102370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/06/2023] [Accepted: 06/09/2023] [Indexed: 07/27/2023]
Abstract
PURPOSE Weight loss is highly prevalent in oesophageal cancer survivors, who often experience disease-related or treatment-related symptoms and quality of life (QoL) impairment. This study aimed to explore the relationships among weight loss, symptom distress, and QoL postoperatively in patients with oesophageal cancer undergoing chemotherapy and to identify the factors influencing the QoL. METHODS We conducted a retrospective observational study with 101 patients and collected data on weight loss (percentage of total body mass loss), QoL (EORTC-QLQ-C30 and EORTC-QLQ-OES-18), and symptom distress (MDASI-GI-C). The associations among weight loss, QoL, and symptom distress were assessed using Pearson's correlation. Multiple linear regression analysis was used to identify independent factors influencing patients' QoL scores. RESULTS The distribution of weight loss of each stage in survivors of oesophageal cancer was 1.00% (SD: 2.48%), 4.69% (SD: 4.73%), 1.66% (SD: 5.37%), 2.83% (SD: 4.89%) respectively. The mean QoL score was 66.24 (SD 18.65). The participants' mean symptom severity and symptom interference scores were 3.30 (SD 1.74) and 2.76 (SD 1.90), respectively. Weight loss and symptom distress were negatively related to patients' QoL (p < 0.05, p < 0.01, respectively). Weight loss between 6 months before diagnosis and the time of diagnosis (p < 0.05) and symptom interference (p < 0.01) were independent predictors for the QoL. CONCLUSIONS This study suggests that oesophageal cancer survivors with larger weight reduction between 6 months before diagnosis and the time of diagnosis and more symptom distress have a worse QoL. Clinicians should focus more on patients' weight and symptom management to improve their QoL.
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Affiliation(s)
- Shumin Jia
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Yanhong Chen
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Jiqiang Cui
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Tongyao Wang
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Chia-Chin Lin
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong.
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9
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Fuhse K. [Weight, nutrition, quality of life-Perspective of oncological patients]. INNERE MEDIZIN (HEIDELBERG, GERMANY) 2023:10.1007/s00108-023-01528-8. [PMID: 37221380 DOI: 10.1007/s00108-023-01528-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/25/2023] [Indexed: 05/25/2023]
Abstract
Nutrition is associated with pleasure and quality of life. The majority of oncological patients experience tumor-associated and treatment-associated nutrition-related symptoms and malnutrition. Consequently, the perception of nutrition during the course of the disease is increasingly more characterized by negative associations, which may persist for years after the end of treatment. This leads to a decreased quality of life, social isolation and a burden for relatives. In contrast, weight loss is initially positively perceived, especially by patients who previously perceived themselves as being overweight, until malnutrition becomes evident and leads to a decreased quality of life. Nutritional counseling can prevent weight loss, relieve adverse side effects, improve the quality of life and reduce mortality. Patients are not aware of this and the German healthcare system lacks structured and firmly established access pathways to nutritional counseling. Therefore, oncological patients need to be informed about the consequences of weight loss at an early stage and low-threshold access to nutritional counseling needs to be comprehensively implemented. Thus, malnutrition can be recognized and treated at an early stage and nutrition can contribute to a higher quality of life as a positively perceived daily activity.
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Affiliation(s)
- Katrin Fuhse
- Klinikum Bremen Mitte, Medizinische Klinik II, St.-Jürgen-Str. 1, 28205, Bremen, Deutschland.
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10
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Katz A, Nevo Y, Ramírez García Luna JL, Anchouche S, Tankel J, Caminsky N, Mueller C, Spicer J, Cools-Lartigue J, Ferri L. Long-Term Quality of Life After Esophagectomy for Esophageal Cancer. Ann Thorac Surg 2023; 115:200-208. [PMID: 35926638 DOI: 10.1016/j.athoracsur.2022.07.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 06/21/2022] [Accepted: 07/19/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Surgery, as part of a multimodal approach, offers the greatest chance of cure for esophageal cancer. However, esophagectomy is often perceived as having a lasting impact on quality of life (QOL), biasing some physicians and patients toward nonoperative management. A comprehensive understanding of the dynamic changes in patient-centered outcomes is therefore important for decision making. Our objective was to determine the long-term QOL after esophagectomy. METHODS Data were obtained from a prospectively collected (2006-2015) esophagectomy database at a high-volume center, and patients surviving 3 or more years were identified. Health-related QOL was evaluated using the Functional Assessment of Cancer Therapy-Esophageal Module (FACT-E) at diagnosis and every 3 to 6 months, and was stratified according to operative approach, stage, and complications. In addition, QOL scores were compared with normative population values. RESULTS Of 480 patients, 47% (n = 226) survived 3 or more years and 70% (158 of 226) completed the health-related QOL assessments. Time of follow-up was 5.1 ± 2.8 years. After a reduction at 1 to 3 months, FACT-E increased from a baseline of 126 (95% CI, 121-131) to 133 (95% CI, 127-139) at 12 months, and to 147 (95% CI, 142-153) by 5 years. There was no difference in long-term FACT-E with respect to the surgical approach, clinical and pathologic stage, or postoperative complications. At long-term follow-up (more than 3 years), QOL did not differ significantly from the normative population reference values. CONCLUSIONS The long-term QOL of esophagectomy patients surviving at least 3 years is improved when compared with the time of diagnosis and does not differ from the general population.
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Affiliation(s)
- Amit Katz
- Division of Thoracic and Upper Gastrointestinal Surgery, Department of Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Yehonatan Nevo
- Division of Thoracic and Upper Gastrointestinal Surgery, Department of Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | | | - Sonia Anchouche
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - James Tankel
- Division of Thoracic and Upper Gastrointestinal Surgery, Department of Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Natasha Caminsky
- Division of Thoracic and Upper Gastrointestinal Surgery, Department of Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Carmen Mueller
- Division of Thoracic and Upper Gastrointestinal Surgery, Department of Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Jonathan Spicer
- Division of Thoracic and Upper Gastrointestinal Surgery, Department of Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Jonathan Cools-Lartigue
- Division of Thoracic and Upper Gastrointestinal Surgery, Department of Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Lorenzo Ferri
- Division of Thoracic and Upper Gastrointestinal Surgery, Department of Surgery, McGill University Health Center, Montreal, Quebec, Canada.
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11
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Yamamoto K, Tanaka K, Yamasaki M, Yamashita K, Makino T, Saito T, Yamamoto K, Takahashi T, Kurokawa Y, Nakajima K, Eguchi H, Doki Y. Early postoperative weight loss is associated with poor prognosis in patients with esophageal cancer. Esophagus 2022; 19:596-603. [PMID: 35857177 DOI: 10.1007/s10388-022-00937-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 06/19/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Surgery for esophageal cancer (EC) causes morphological and functional changes in the upper gastrointestinal tract, resulting in postoperative weight loss (PWL). PWL has been shown to lead to poor nutritional status and immunocompetence, which may worsen the prognosis for several types of cancer. However, few reports have examined the relationship between weight loss (WL) in the early postoperative period and cancer prognosis. METHODS A total of 421 esophageal cancer patients underwent curative esophagectomy at Osaka University Hospital from 2010 to 2016. Based on the patients' body weight 1.5 months after surgery, they were classified into severe WL (n = 50) and slight-moderate WL (n = 371) groups. RESULTS The 5-year overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS) were significantly lower in the severe WL group than the slight-moderate WL group (p = 0.0002, p < 0.0001, and p = 0.0004, respectively). In the multivariate analysis, tumor invasion depth (pT3, 4), lymph node metastasis (pN2, 3), preoperative Prognostic Nutrition Index (< 45), postoperative complications (≥ G3), and severe WL were independent prognostic factors for CSS (hazard ratio [HR] 2.5, 95% confidence interval [CI] 1.7-3.7; HR 1.6, 95% CI 1.1-2.4; HR 1.9, 95% CI 1.3-2.8; HR 1.6, 95% CI 1.1-2.4; and HR 2.7, 95% CI 1.7-4.2, respectively). In a multivariate analysis of risk factors leading to severe WL, thoracotomy (VATS) and postoperative MAX CRP (high) were independent risk factors (odds ratio [OR 0.48, 95% CI 0.24-0.97; OR 1.9, 95% CI 1.0-3.5). CONCLUSION Early PWL would be a useful marker of poor cancer prognosis in EC patients. Highly inflammatory conditions due to surgical invasion and postoperative complications may contribute to early PWL.
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Affiliation(s)
- Kei Yamamoto
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2-E2, Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Koji Tanaka
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2-E2, Yamada-oka, Suita, Osaka, 565-0871, Japan.
| | - Makoto Yamasaki
- Department of Surgery, Kansai Medical University, Osaka, Japan
| | - Kotaro Yamashita
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2-E2, Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Tomoki Makino
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2-E2, Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Takuro Saito
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2-E2, Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Kazuyoshi Yamamoto
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2-E2, Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Tsuyoshi Takahashi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2-E2, Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Yukinori Kurokawa
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2-E2, Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Kiyokazu Nakajima
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2-E2, Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Hidetoshi Eguchi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2-E2, Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2-E2, Yamada-oka, Suita, Osaka, 565-0871, Japan
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12
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Sugawara K, Yagi K, Aikou S, Yamashita H, Seto Y. Impacts of complications after esophageal cancer surgery on health-related quality of life and nutritional status. Gen Thorac Cardiovasc Surg 2022; 70:1048-1057. [PMID: 35788889 DOI: 10.1007/s11748-022-01846-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 06/07/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The long-term impacts of post-operative complications, especially pulmonary complications and anastomotic leakage, on health-related quality of life (HRQoL), nutritional status and body composition remain to be fully addressed in patients undergoing esophageal cancer surgery. METHODS Patients who underwent esophagectomy between 2015 and 2019 and survived without recurrence were eligible. HRQoL (European Organization for Research and Treatment of Cancer QLQ-C30 and the QLQ-OES18 questionnaires), nutritional and body composition data were prospectively evaluated before and at 3, 6, 12 and 24 months after surgery. Collected data were compared between patients with post-operative complications and those without. RESULTS In total, 88 patients were included. Overall complications, anastomotic leakage and pulmonary complications developed in 48 (54.5%), 20 (20.7%) and 18 (20.5%) patients, respectively. Patients with pulmonary complications had significantly more reflux-related symptoms (dry mouth; P = 0.03, coughing; P = 0.047), and more difficulties with eating at 24 months after surgery, as compared to those without such complications. Anastomotic leakage increased pain, speaking problems and dysphagia up to 6 months after surgery. Patients with pulmonary complications had significantly lower prealbumin levels (P = 0.01, 0.02 and 0.008 at 6, 12 and 24 months after surgery, respectively) and lower prognostic nutritional index values over time after surgery than those without these complications. In contrast, anastomotic leakage was not associated with poor nutritional status post-operatively. Body composition was not affected by the occurrence of complications. CONCLUSION Patients who developed post-operative complications, especially pulmonary complications, had long-lasting negative HRQoL outcomes and poor nutritional status after esophagectomy.
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Affiliation(s)
- Kotaro Sugawara
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Koichi Yagi
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Susumu Aikou
- Division of Frontier Surgery, Advanced Clinical Research Center, Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Hiroharu Yamashita
- Department of Digestive Surgery, Surugadai Nihon University Hospital, Tokyo, Japan
| | - Yasuyuki Seto
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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13
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Bennett S, Murphy CF, Fanning M, Reynolds JV, Doyle SL, Donohoe CL. The impact of Nutrition and Gastrointestinal Symptoms on Health-related Quality of Life in Survivorship after Oesophageal Cancer Surgery. CLINICAL NUTRITION OPEN SCIENCE 2022. [DOI: 10.1016/j.nutos.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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14
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Mertens A, Gooszen J, Fockens P, Voermans R, Gisbertz S, Bredenoord A, van Berge Henegouwen MI. Treating Early Delayed Gastric Tube Emptying after Esophagectomy with Pneumatic Pyloric Dilation. Dig Surg 2022; 38:337-342. [PMID: 34727541 PMCID: PMC8820434 DOI: 10.1159/000519785] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 08/26/2021] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Endoscopic pneumatic pyloric balloon dilation is a treatment option for early postoperative delayed gastric tube emptying following esophageal resection. This study aimed to determine the safety and effectiveness of endoscopic balloon dilation. METHODS Between 2015 and 2018, patients with delayed gastric emptying 8-10 days after esophageal resection with gastric tube reconstruction due to esophageal carcinoma were considered for inclusion. Inclusion criteria were ≥1 of the following: nasogastric tube production ≥500 mL/24 h, ≥300 mL gastric retention, ≥50% gastric tube dilatation on X-ray, or nasogastric tube replacement. Patients were excluded on evidence of anastomotic leakage or reintervention. Success was defined as the ability to expand intake without needing to replace the nasogastric tube. Dilation was performed using a 30-mm Rigiflex balloon. RESULTS Fifteen patients underwent pyloric dilation, 12 according to the study protocol. Treatment was performed at a median of 12 days (IQR 9-15) postoperatively. Success was achieved in 58%. At 3 months, 8 patients progressed to exclusively oral intake. The remaining 4 patients had supplementary nightly enteral tube feeding. There were no adverse events. CONCLUSION Endoscopic balloon dilation of the pylorus is a safe, feasible therapy for early postoperative delayed gastric emptying. With a success rate of 58%, a clinical trial is a necessary next step.
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Affiliation(s)
- Alexander Mertens
- Department of Surgery, Amsterdam University Medical Centers, location AMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands,Robotics and Mechatronics, University of Twente, Enschede, The Netherlands,*Alexander Mertens,
| | - Jan Gooszen
- Department of Surgery, Amsterdam University Medical Centers, location AMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Paul Fockens
- Department of Gastroenterology & Hepatology, Amsterdam University Medical Centers, location AMC, University of Amsterdam, Amsterdam Gastroenterology & Metabolism, Amsterdam, The Netherlands
| | - Rogier Voermans
- Department of Gastroenterology & Hepatology, Amsterdam University Medical Centers, location AMC, University of Amsterdam, Amsterdam Gastroenterology & Metabolism, Amsterdam, The Netherlands
| | - Suzanne Gisbertz
- Department of Surgery, Amsterdam University Medical Centers, location AMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Arjan Bredenoord
- Department of Gastroenterology & Hepatology, Amsterdam University Medical Centers, location AMC, University of Amsterdam, Amsterdam Gastroenterology & Metabolism, Amsterdam, The Netherlands
| | - Mark Ivo van Berge Henegouwen
- Department of Surgery, Amsterdam University Medical Centers, location AMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands,**Mark Ivo Van Berge Henegouwen,
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15
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Boshier PR, Klevebro F, Savva KV, Waller A, Hage L, Hanna GB, Low DE. Assessment of Health Related Quality of Life and Digestive Symptoms in Long-term, Disease Free Survivors After Esophagectomy. Ann Surg 2022; 275:e140-e147. [PMID: 32068555 DOI: 10.1097/sla.0000000000003829] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to investigate long-term HRQOL and symptom evolution in disease free patients up to 20 years after esophagectomy. BACKGROUND Esophagectomy has been associated with decreased HRQOL and persistent gastrointestinal symptoms. METHODS The study cohort was identified from 2 high volume centers for the management of esophageal cancer. Patients completed HRQOL and symptom questionnaires, including: Digestive Symptom Questionnaire, EORTC QLQ-C30, EORTC QLQ-OG25 Euro QoL 5D, and SF36. Patients were assessed in 3 cohorts: <1 year; 1-5 years, and; >5 years after surgery. RESULTS In total 171 of 222 patients who underwent esophagectomy between 1991 and 2017 who met inclusion criteria and were contactable, responded to the questionnaires, corresponding to a response rate of 77%. Median age was 66.2 years, and median time from operation to survey was 5.6 years (range 0.3-23.1). Early satiety was the most commonly reported symptom in all patients irrespective of timeframe (87.4%; range 82%-92%). Dysphagia was seen to decrease over time (58% at <2 years; 28% at 2-5 years; 20% at >5 years; P = 0.013). Weight loss scores demonstrated nonstatistical improvement over time. All other symptom scores including heartburn, regurgitation, respiratory symptoms, and pain scores remained constant over time. Average HRQOL did not improve from levels 1 year after surgery compared to patients up to 23 years after esophagectomy. CONCLUSION With the exception of dysphagia, which improved over time, esophagectomy was associated with decreased HRQOL and lasting gastrointestinal symptoms up to 20 years after surgery. Pertinently however long-term survivors after oesophagectomy demonstrated comparable to improved HRQOL compared to the general population. The impact of esophagectomy on gastrointestinal symptoms and long-term HRQOL should be considered when counseling and caring for patients undergoing esophagectomy.
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Affiliation(s)
- Piers R Boshier
- Department of Thoracic Surgery and Thoracic Oncology, Virginia Mason Medical Center, Seattle, WA
- Department of Surgery and Cancer, Imperial College London, UK
| | - Fredrik Klevebro
- Department of Thoracic Surgery and Thoracic Oncology, Virginia Mason Medical Center, Seattle, WA
- Department of Surgery, Karolinska Institutet, Sweden
| | | | - Anabelle Waller
- Department of Surgery and Cancer, Imperial College London, UK
| | - Lory Hage
- Department of Surgery and Cancer, Imperial College London, UK
| | - George B Hanna
- Department of Surgery and Cancer, Imperial College London, UK
| | - Donald E Low
- Department of Thoracic Surgery and Thoracic Oncology, Virginia Mason Medical Center, Seattle, WA
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16
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Wang P, Liu Q, Chen X, Liu X, Li Y. The negative association between skeletal muscle and fat mass wasting caused by oesophagectomy in patients with oesophageal squamous cell carcinoma. Eur J Cardiothorac Surg 2021; 61:259-266. [PMID: 34392342 DOI: 10.1093/ejcts/ezab377] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 06/26/2021] [Accepted: 07/14/2021] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES This prospective observational study aimed to investigate postoperative skeletal muscle and fat mass wasting and their clinical significance in oesophageal cancer patients undergoing minimally invasive McKeown oesophagectomy. METHODS Bioelectrical impedance analyses of body compositions were conducted before surgery and 1, 4 and 12 weeks after surgery. Curve-fitting analysis was used to describe the relationship between changes in the skeletal muscle mass index (ΔSMI) and fat mass index (ΔFMI). A logistic regression-based nomogram was established using the R tool. RESULTS Among the 78 patients, 74.4% were male, and the mean age was 64.8 [standard deviation (SD): 6.6] years. Decreased SMIs and FMIs were concentrated in the first 4 weeks after surgery, with proportions of -3.42% (SD: 4.58) and -17.7% (SD: 11.9), respectively. A negative relationship between ΔFMI and ΔSMI was detected by linear regression (coefficient -0.341, P < 0.001). Based on the median ΔSMI to ΔFMI ratio (35.5%), 2 postoperative weight loss types were defined: SMI-dominated (SMDT) and FMI-dominated (FMDT) types. SMDT patients reported increased feeding-related problems, poorer functional status and more unhealthy symptoms than FMDT patients within 12 weeks after surgery. SMDT patients also showed poorer 2-year overall survival (71.1% vs 87.3%, P = 0.021) and disease-free survival (60.5% vs 84.9%, P = 0.032) than FMDT patients. A nomogram based on baseline and perioperative parameters was established to quantify postoperative SMDT and FMDT tendencies with good accuracy (C-index: 0.897). CONCLUSIONS The negative relationship between ΔFMI and ΔSMI indicated differentiated metabolism post-oesophagectomy. SMDT was associated with adverse therapeutic outcomes and warranted aggressive interventions. CLINICAL REGISTRATION NUMBER The study protocol was registered at the Chinese Clinical Trial Registry with the registration number ChiCTR1800018511.
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Affiliation(s)
- Peiyu Wang
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China.,Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Qi Liu
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiankai Chen
- Department of Thoracic Surgical Oncology, National Cancer Center/Cancer Hospital, Beijing, China
| | - Xianben Liu
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Yin Li
- Department of Thoracic Surgical Oncology, National Cancer Center/Cancer Hospital, Beijing, China
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17
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Liu Y, Pettersson E, Schandl A, Markar S, Johar A, Lagergren P. Higher Dispositional Optimism Predicts Better Health-Related Quality of Life After Esophageal Cancer Surgery: A Nationwide Population-Based Longitudinal Study. Ann Surg Oncol 2021; 28:7196-7205. [PMID: 33876352 PMCID: PMC8521517 DOI: 10.1245/s10434-021-10026-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/26/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE To assess whether higher dispositional optimism could predict better health-related quality of life (HRQL) after esophageal cancer surgery. METHODS This Swedish nationwide longitudinal study included 192 patients who underwent esophagectomy for cancer. The exposure was dispositional optimism measured by the Life Orientation Test-Revised (LOT-R) at 1 year post-surgery. Patients were categorized into four subgroups (very low, moderately low, moderately high, and very high dispositional optimism) based on the quartile of the LOT-R sum score. The outcome was HRQL assessed by the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Core 30 (QLQ-C30) and Quality of Life Questionnaire-Esophago-Gastric module 25 (QLQ-OG25) at 1, 1.5, and 2 years post-surgery. Linear mixed-effects models, adjusted for potential confounders, were used to examine the mean score difference (MSD) with 95% confidence interval of HRQL among the four patient subgroups. RESULTS Patients with very high dispositional optimism reported clinically relevantly better global quality of life, emotional function, and social function (MSD range 10-16) and less severe symptoms in pain, dyspnea, diarrhea, eating difficulty, anxiety, dry mouth, trouble with taste, worry about weight loss, and self-doubt about body image (MSD range - 9 to - 22) than patients with lower dispositional optimism. Patients with moderately high dispositional optimism reported clinically and statistically significantly better global quality of life (MSD 10) and less severe diarrhea (MSD - 9) than patients with lower dispositional optimism. Adjusted MSDs were constant over the three time points in all aspects except for eating difficulty. CONCLUSIONS Measuring dispositional optimism could help identify patients at higher risk of poor HRQL recovery after esophageal cancer surgery.
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Affiliation(s)
- Yangjun Liu
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Erik Pettersson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Anna Schandl
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.,Department of Anesthesiology and Intensive Care, Södersjukhuset, Stockholm, Sweden
| | - Sheraz Markar
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - Asif Johar
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Pernilla Lagergren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden. .,Department of Surgery and Cancer, Imperial College London, London, UK.
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18
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Kubo Y, Tanaka K, Yamasaki M, Yamashita K, Makino T, Saito T, Yamamoto K, Takahashi T, Kurokawa Y, Motoori M, Kimura Y, Nakajima K, Eguchi H, Doki Y. Influences of the Charlson Comorbidity Index and Nutrition Status on Prognosis After Esophageal Cancer Surgery. Ann Surg Oncol 2021; 28:7173-7182. [PMID: 33835302 DOI: 10.1245/s10434-021-09779-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 02/09/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND The Charlson Comorbidity Index (CCI), an indicator that objectively quantifies comorbidities, reduces nutritional status; however, the impact of the CCI on the postoperative nutrition indexes of patients with esophageal cancer remains unclear. METHODS In total, 336 patients with esophageal cancer who underwent surgery between January 2011 and April 2017 were included in this study. We investigated the relationship between the CCI and postoperative nutrition indexes. RESULTS Patients were divided into two groups: CCI ≤1 (low CCI group) and CCI ≥2 (high CCI group). A high CCI was significantly associated with shortened overall survival (OS; 3-year OS rate of 77.9% in the low CCI group versus 59.7% in the high CCI group; p = 0.008). Nutritional indexes, such as the Prognostic Nutritional Index (PNI), at 1 month after esophagectomy were significantly lower in the high CCI group than in the low CCI group (p = 0.031); however, the PNI at 6 months after surgery was similar between the high and low CCI groups. Multivariate analysis identified high CCI as an independent risk factor associated with PNI <45 in esophageal cancer patients at 1 month after esophagectomy (p = 0.047). CONCLUSION This study showed that CCI ≥2 was significantly associated with poor PNI at 1 month after surgery for esophageal cancer, indicating that it is necessary to administer effective nutritional interventions for patients with postoperative malnutrition, especially those with multiple comorbidities.
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Affiliation(s)
- Yuto Kubo
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Koji Tanaka
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan.
| | - Makoto Yamasaki
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Kotaro Yamashita
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Tomoki Makino
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Takuro Saito
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Kazuyoshi Yamamoto
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Tsuyoshi Takahashi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yukinori Kurokawa
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Masaaki Motoori
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yutaka Kimura
- Department of Surgery, Faculty of Medicine, Kindai University, Osaka-Sayama, Japan
| | - Kiyokazu Nakajima
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Hidetoshi Eguchi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
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19
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Murphy CF, Fanning M, Raftery N, Elliott JA, Docherty NG, Donohoe CL, Ravi N, le Roux CW, Reynolds JV. Early experience with a nutrition and survivorship clinic in esophageal cancer. Dis Esophagus 2021; 34:5860595. [PMID: 32566939 DOI: 10.1093/dote/doaa061] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/24/2020] [Accepted: 05/28/2020] [Indexed: 12/11/2022]
Abstract
Improved cure rates in esophageal cancer care have increased focus on health-related quality of life (HRQL) in survivorship. To optimize recovery after esophagectomy, particularly nutritional well-being, a personalized multidisciplinary survivorship clinic was established at this center. Assessments at 6 and 12 months postoperatively include validated European Organization for the Research and Treatment of Cancer (EORTC) symptom and health-related quality of life (HRQL) questionnaires, functional status review, anthropometry, and biochemical screening for micronutrient deficiencies. 75 patients, at a mean age of 63 years, 84% male, 85% with adenocarcinoma, and 73% receiving multimodal therapy were included. Mean preoperative body mass index (BMI) was 27.5 (4.3) kg m -2. 6- and 12-month assessments were completed by 66 (88%) and 37 (93%) recurrence-free patients, respectively. Mean body weight loss at 6 months was 8.5 ± 6.6% and at 12 months 8.8 ± 7.3%. Of the 12-month cohort, micronutrient deficiency was present in 27 (79.4%) preoperatively and 29 (80.6%) after 1 year (P = 0.727), most commonly iron deficiency (preoperative: 16 [43.2%] and postoperative: 17 [45.9%] patients, P = 0.100). 26 (70.3%) of these patients also had clinically significant dumping syndrome persisting to 12 months after surgery. We describe a novel follow-up support structure for esophageal cancer patients in the first year of survivorship. This may serve as an exemplar model with parallel application across oncological care.
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Affiliation(s)
- Conor F Murphy
- National Center for Esophageal and Gastric Cancer, Department of Surgery, Trinity Centre for Health Sciences, Trinity College Dublin and St. James's Hospital, Dublin, Ireland.,Diabetes Complications Research Centre, Conway Institute for Biomedical Science, University College Dublin, Dublin, Ireland
| | - Michelle Fanning
- Department of Clinical Nutrition, St James's Hospital, Dublin, Ireland
| | - Nicola Raftery
- National Center for Esophageal and Gastric Cancer, Department of Surgery, Trinity Centre for Health Sciences, Trinity College Dublin and St. James's Hospital, Dublin, Ireland
| | - Jessie A Elliott
- National Center for Esophageal and Gastric Cancer, Department of Surgery, Trinity Centre for Health Sciences, Trinity College Dublin and St. James's Hospital, Dublin, Ireland.,Diabetes Complications Research Centre, Conway Institute for Biomedical Science, University College Dublin, Dublin, Ireland
| | - Neil G Docherty
- Diabetes Complications Research Centre, Conway Institute for Biomedical Science, University College Dublin, Dublin, Ireland
| | - Claire L Donohoe
- National Center for Esophageal and Gastric Cancer, Department of Surgery, Trinity Centre for Health Sciences, Trinity College Dublin and St. James's Hospital, Dublin, Ireland
| | - Narayanasamy Ravi
- National Center for Esophageal and Gastric Cancer, Department of Surgery, Trinity Centre for Health Sciences, Trinity College Dublin and St. James's Hospital, Dublin, Ireland
| | - Carel W le Roux
- Diabetes Complications Research Centre, Conway Institute for Biomedical Science, University College Dublin, Dublin, Ireland
| | - John V Reynolds
- National Center for Esophageal and Gastric Cancer, Department of Surgery, Trinity Centre for Health Sciences, Trinity College Dublin and St. James's Hospital, Dublin, Ireland
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20
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Liu YJ, Schandl A, Markar S, Johar A, Lagergren P. Psychological distress and health-related quality of life up to 2 years after oesophageal cancer surgery: nationwide population-based study. BJS Open 2021; 5:6073387. [PMID: 33609371 PMCID: PMC7893460 DOI: 10.1093/bjsopen/zraa038] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 10/12/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Patients are at higher risk of suffering from psychological distress and reduced health-related quality of life (HRQoL) after oesophageal cancer surgery. This Swedish nationwide population-based longitudinal study aimed to evaluate the association between psychological distress and HRQoL up to 2 years after oesophageal cancer surgery. METHODS The study included patients with oesophageal cancer who had survived for 1 year after oesophageal cancer surgery. The exposure was psychological distress measured using the Hospital Anxiety and Depression Scale. Patients scoring at least 8 on either the anxiety or the depression subscale were classified as having psychological distress. The outcome was HRQoL assessed by the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire generic and disease-specific questionnaires (EORTC QLQ-C30 and QLQ-OG25). Exposure and outcome were measured at 1, 1.5, and 2 years after operation. Fixed-effects models with adjustment for all time-invariant confounding and potential time-varying confounders were used to examine the mean score difference in HRQoL between patients with and without psychological distress. RESULTS In total, 180 patients were analysed. Clinically relevant, statistically significant and time-constant mean score differences were found in emotional function, social function, dyspnoea, anxiety, eating difficulty, eating in front of others, and weight loss (mean score difference range 10-29). Mean score differences for global quality of life, cognitive function, appetite loss, EORTC QLQ-C30 summary score, and trouble with taste increased over time, and reached clinical and statistical significance at 1.5 and/or 2 years after surgery. For body image, there was a clinically relevant decrease in mean score difference over time. CONCLUSION Psychological distress was associated with several aspects of poor HRQoL up to 2 years after surgery for oesophageal cancer.
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Affiliation(s)
- Y J Liu
- Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - A Schandl
- Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
- Department of Anaesthesiology and Intensive Care, Södersjukhuset, Stockholm, Sweden
| | - S Markar
- Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - A Johar
- Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - P Lagergren
- Correspondence to: Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Retzius väg 13 a, Level 4, 171 77 Stockholm, Sweden (e-mail: )
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21
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Murphy CF, Stratford N, Docherty NG, Moran B, Elliott JA, Healy ML, McMorrow JP, Ravi N, Goldstone AP, Reynolds JV, le Roux CW. A Pilot Study of Gut-Brain Signaling After Octreotide Therapy for Unintentional Weight Loss After Esophagectomy. J Clin Endocrinol Metab 2021; 106:e204-e216. [PMID: 33000149 DOI: 10.1210/clinem/dgaa697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/24/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Recurrence-free patients after esophageal cancer surgery face long-term nutritional consequences, occurring in the context of an exaggerated postprandial gut hormone response. Acute gut hormone suppression influences brain reward signaling and eating behavior. This study aimed to suppress gut hormone secretion and characterize reward responses and eating behavior among postesophagectomy patients with unintentional weight loss. METHODS This pilot study prospectively studied postoperative patients with 10% or greater body weight loss (BWL) beyond 1 year who were candidates for clinical treatment with long-acting octreotide (LAR). Before and after 4 weeks of treatment, gut hormone secretion, food cue reactivity (functional magnetic resonance imaging), eating motivation (progressive ratio task), ad libitum food intake, body composition, and symptom burden were assessed. RESULTS Eight patients (7 male, age: mean ± SD 62.8 ± 9.4 years, postoperative BWL: 15.5 ± 5.8%) participated. Octreotide LAR did not significantly suppress total postprandial plasma glucagon-like peptide-1 response at 4 weeks (P = .08). Postprandial symptom burden improved after treatment (Sigstad score median [range]: 12 [2-28] vs 8 [3-18], P = .04) but weight remained stable (pre: 68.6 ± 12.8 kg vs post: 69.2 ± 13.4 kg, P = .13). There was no significant change in brain reward system responses, during evaluation of high-energy or low-energy food pictures, nor their appeal rating. Moreover, treatment did not alter motivation to eat (P = .41) nor ad libitum food intake(P = .46). CONCLUSION The protocol used made it feasible to characterize the gut-brain axis and eating behavior in this cohort. Inadequate suppression of gut hormone responses 4 weeks after octreotide LAR administration may explain the lack of gut-brain pathway alterations. A higher dose or shorter interdose interval may be required to optimize the intervention.
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Affiliation(s)
- Conor F Murphy
- Diabetes Complications Research Centre, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin 4, Ireland
- National Oesophageal and Gastric Centre, Trinity Centre for Health Sciences, Trinity College Dublin and St. James's Hospital, Dublin, Ireland
| | - Nicholas Stratford
- Diabetes Complications Research Centre, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin 4, Ireland
| | - Neil G Docherty
- Diabetes Complications Research Centre, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin 4, Ireland
| | - Brendan Moran
- Diabetes Complications Research Centre, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin 4, Ireland
| | - Jessie A Elliott
- Diabetes Complications Research Centre, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin 4, Ireland
- National Oesophageal and Gastric Centre, Trinity Centre for Health Sciences, Trinity College Dublin and St. James's Hospital, Dublin, Ireland
| | | | | | - Narayanasamy Ravi
- National Oesophageal and Gastric Centre, Trinity Centre for Health Sciences, Trinity College Dublin and St. James's Hospital, Dublin, Ireland
| | - Anthony P Goldstone
- PsychoNeuroEndocrinology Research Group, Centre for Neuropsychopharmacology, Division of Psychiatry, and Computational, Cognitive, and Clinical Neuroimaging Laboratory, Department of Brain Sciences, Faculty of Medicine, Imperial College London, Hammersmith Hospital, London, UK
| | - John V Reynolds
- National Oesophageal and Gastric Centre, Trinity Centre for Health Sciences, Trinity College Dublin and St. James's Hospital, Dublin, Ireland
| | - Carel W le Roux
- Diabetes Complications Research Centre, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin 4, Ireland
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22
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Similar Quality of Life and Safety in Patients Receiving Inpatient or Outpatient Chemotherapy: A Focus on Esophageal Squamous Cell Carcinoma. Healthcare (Basel) 2020; 8:healthcare8040447. [PMID: 33139637 PMCID: PMC7711819 DOI: 10.3390/healthcare8040447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/26/2020] [Accepted: 10/30/2020] [Indexed: 11/23/2022] Open
Abstract
Quality of life (QoL) is a particularly important issue for cancer patients. This study was designed to investigate the differences in QoL in esophageal squamous cell carcinoma (ESCC) patients who underwent inpatient chemotherapy (IPCT) or outpatient chemotherapy (OPCT). A total of 107 ESCC patients were enrolled, including 53 patients in the IPCT group and 54 patients in the OPCT group. The widely used and well-validated instruments European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 Items (EORTC QLQ-C30) and Oesophageal Cancer Module (EORTC QLQ-OES18) were used to examine the QoL of the two groups. In addition, the differences in adverse events (AEs) were evaluated. The results of QLQ C-30 analysis showed that mean global quality of life scores were similar between IPCT and OPCT groups, as were functional and symptom scales. There were no significant differences in the functional and symptom scales in the analysis of QLQ OES18 either. Most AEs of chemotherapy were grades 1–2, and the majority of patients tolerated the side effects; no statistically significant difference in AEs between these two groups was mentioned. Our study suggests that the health-related QoL and adverse events in ESCC patients who received IPCT or OPCT are similar. OPCT is reasonable and safe in clinical practice.
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23
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Mehdorn AS, Möller T, Franke F, Richter F, Kersebaum JN, Becker T, Egberts JH. Long-Term, Health-Related Quality of Life after Open and Robot-Assisted Ivor-Lewis Procedures-A Propensity Score-Matched Study. J Clin Med 2020; 9:jcm9113513. [PMID: 33142987 PMCID: PMC7693702 DOI: 10.3390/jcm9113513] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/20/2020] [Accepted: 10/25/2020] [Indexed: 02/07/2023] Open
Abstract
Esophagectomies are among the most invasive surgical procedures that highly influence health-related quality of life (HRQoL). Recent improvements have helped to achieve longer survival. Therefore, long-term postoperative HRQoL needs to be emphasized in addition to classic criterions like morbidity and mortality. We aimed to compare short and long-term HRQoL after open transthoracic esophagectomies (OTEs) and robotic-assisted minimally invasive esophagectomies (RAMIEs) in patients suffering from esophageal adenocarcinoma. Prospectively collected HRQoL-data (from the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire-C30 (EORTC QLQ-C30)) were correlated with clinical courses. Only patients suffering from minor postoperative complications (Clavien-Dindo Classification of < 2) after R0 Ivor-Lewis-procedures were included. Age, sex, body mass index (BMI), American Society of Anesthesiologists physical status-score (ASA-score), tumor stage, and perioperative therapy were used for propensity score matching (PSM). Twelve RAMIE and 29 OTE patients met the inclusion criteria. RAMIE patients reported significantly better emotional and social function while suffering from significantly less pain and less physical impairment four months after surgery. The long-term follow up confirmed the results. Long-term postoperative HRQoL and self-perception partly exceeded the levels of the healthy reference population. Minor operative trauma by robotic approaches resulted in significantly reduced physical impairments while improving HRQoL and self-perception, especially in the long-term. However, further long-term results are warranted to confirm this positive trend.
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24
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Kanayama N, Otozai S, Yoshii T, Toratani M, Ikawa T, Wada K, Hirata T, Morimoto M, Konishi K, Ogawa K, Fujii T, Teshima T. Death unrelated to cancer and death from aspiration pneumonia after definitive radiotherapy for head and neck cancer. Radiother Oncol 2020; 151:266-272. [PMID: 32866561 DOI: 10.1016/j.radonc.2020.08.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 07/21/2020] [Accepted: 08/24/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND PURPOSE The incidence of hypopharyngeal and supraglottic cancer (HSC) is high in Japan. This study aimed to retrospectively identify risk factors for death unrelated to cancer and death from aspiration pneumonia after definitive radiotherapy (RT) for HSC. MATERIALS AND METHODS Overall, 391 patients who began definitive RT for HSC between 2006 and 2014 were identified from the Osaka International Cancer Institute electronic database. Among 391 patients, 33 had a history of surgery for esophageal cancer (EC) and 19 received simultaneous RT for synchronous EC. The cause of death was divided into 3 main categories: "cancer under study," "other malignancy," and "unrelated to cancer." Cox proportional hazard model was used to estimate the hazard ratio (HR). RESULTS The median follow-up for survivors was 8 (range 3.6-14.1) years. At the last follow-up, 202 patients died. Death from "cancer under study," "other malignancy," and "unrelated to cancer" occurred in 92 (45.5%), 55 (27.2%), and 55 (27.2%) patients, respectively. Twelve patients died from aspiration pneumonia. In multivariate analysis for death unrelated to cancer and death from aspiration pneumonia, history of surgery for EC (HR: 3.87, p < 0.001; HR: 6.84, p = 0.007, respectively) and simultaneous RT for synchronous EC (HR: 3.74, p = 0.006; HR: 16.37, p < 0.001, respectively) were significant risk factors. CONCLUSION The laryngeal preservation approach by RT for HSC patients with a history of surgery for EC and simultaneous RT for synchronous EC should be used with caution.
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Affiliation(s)
- Naoyuki Kanayama
- Department of Radiation Oncology, Osaka International Center Institute, Osaka, Japan.
| | - Shinji Otozai
- Department of Head and Neck Surgery, Osaka International Center Institute, Osaka, Japan
| | - Tadashi Yoshii
- Department of Head and Neck Surgery, Osaka International Center Institute, Osaka, Japan
| | - Masayasu Toratani
- Department of Radiation Oncology, Osaka International Center Institute, Osaka, Japan
| | - Toshiki Ikawa
- Department of Radiation Oncology, Osaka International Center Institute, Osaka, Japan
| | - Kentaro Wada
- Department of Radiation Oncology, Osaka International Center Institute, Osaka, Japan
| | - Takero Hirata
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masahiro Morimoto
- Department of Radiation Oncology, Osaka International Center Institute, Osaka, Japan
| | - Koji Konishi
- Department of Radiation Oncology, Osaka International Center Institute, Osaka, Japan
| | - Kazuhiko Ogawa
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takashi Fujii
- Department of Head and Neck Surgery, Osaka International Center Institute, Osaka, Japan
| | - Teruki Teshima
- Department of Radiation Oncology, Osaka International Center Institute, Osaka, Japan
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25
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Yang HC, Choi JH, Kim MS, Lee JM. Delayed Gastric Emptying after Esophagectomy: Management and Prevention. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 53:226-232. [PMID: 32793457 PMCID: PMC7409889 DOI: 10.5090/kjtcs.2020.53.4.226] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/10/2020] [Accepted: 07/16/2020] [Indexed: 11/16/2022]
Abstract
The quality of life associated with eating is becoming an increasingly significant problem for patients who undergo esophagectomy as a result of the improved survival rate after esophageal cancer surgery. Delayed gastric emptying (DGE) is a common complication after esophagectomy. Although several strategies have been proposed for the management and prevention of DGE, no clear consensus exists. The purpose of this review is to present a brief overview of DGE and to help clinicians choose the most appropriate treatment through an analysis of DGE by cause. Furthermore, we would like to suggest some tips to prevent DGE based on our experience.
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Affiliation(s)
- Hee Chul Yang
- Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Jin Ho Choi
- Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Moon Soo Kim
- Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Jong Mog Lee
- Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
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26
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Triantafyllou T, Wijnhoven B. Multidisciplinary treatment of esophageal cancer: The role of active surveillance after neoadjuvant chemoradiation. Ann Gastroenterol Surg 2020; 4:352-359. [PMID: 32724878 PMCID: PMC7382442 DOI: 10.1002/ags3.12350] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 03/29/2020] [Accepted: 05/05/2020] [Indexed: 12/21/2022] Open
Abstract
The optimal treatment of esophageal cancer is still controversial. Neoadjuvant chemoradiotherapy followed by radical esophagectomy is a standard treatment. Morbidity after esophagectomy however is still considerable and has an impact on patients' quality of life. Given a pathologic complete response rate of approximately 30% in patients after neoadjuvant chemoradiation followed by surgery, active surveillance has been introduced as a new alternative approach. Active surveillance involves regular clinical response evaluations in patients after neoadjuvant therapy to detect residual or recurrent disease. As long as there is no suspicion of disease activity, surgery is withheld. Esophagectomy is reserved for patients presenting with an incomplete response or resectable recurrent disease. Active surveillance after neoadjuvant treatment has been previously applied in other types of malignancy with encouraging results. This paper discusses its role in esophageal cancer.
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Affiliation(s)
- Tania Triantafyllou
- Department of SurgeryHippocration General Hospital of AthensNational and Kapodistrian University of AthensAthensGreece
| | - Bas Wijnhoven
- Department of SurgeryErasmus University Medical CenterRotterdamthe Netherlands
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27
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Kubo Y, Miyata H, Sugimura K, Shinno N, Asukai K, Hasegawa S, Yanagimoto Y, Yamada D, Yamamoto K, Nishimura J, Wada H, Takahashi H, Yasui M, Omori T, Ohue M, Yano M. Prognostic Implication of Postoperative Weight Loss After Esophagectomy for Esophageal Squamous Cell Cancer. Ann Surg Oncol 2020; 28:184-193. [PMID: 32591956 DOI: 10.1245/s10434-020-08762-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND Preoperative weight loss in esophageal cancer is reported to be associated with a poor prognosis. However, the impact of postoperative weight loss on the prognosis of patients with esophageal cancer remains unclear. METHODS This study included 186 patients with esophageal squamous cell carcinoma who underwent surgery between January 2012 and January 2015. The relationship between weight loss 6 months after esophagectomy as well as the clinical factors and prognosis of patients was investigated. RESULTS The mean weight loss rate for all the patients was 9.3% at 3 months, 10.8% at 6 months, 11.1% at 12 months, and 11.4% at 24 months after surgery. The patients with severe weight loss 6 months after surgery (≥ 12%) exhibited lower serum albumin levels and a lower prognostic nutrition index 6 months after esophagectomy than the patients with moderate weight loss (< 12%; p = 0.011 and 0.009, respectively). Although overall survival did not differ significantly between the two groups, for all the patients, severe weight loss was significantly associated with shortened overall survival for the cStages 3 and 4 patients (3-year overall survival rate, 76.6% in the moderate group vs 54.5% in the severe group; p = 0.042). The multivariate analyses identified only severe weight loss as an independent factor associated with worse overall survival for the cStages 3 and 4 patients (p = 0.034). CONCLUSION This study showed that postoperative weight loss negatively affected the prognosis for patients with advanced esophageal cancer, indicating the necessity of administering nutritional interventions to these patients to prevent postoperative weight loss.
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Affiliation(s)
- Yuto Kubo
- Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Hiroshi Miyata
- Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan.
| | - Keijiro Sugimura
- Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Naoki Shinno
- Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Kei Asukai
- Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Shinitiro Hasegawa
- Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Yoshitomo Yanagimoto
- Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Daisaku Yamada
- Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Kazuyoshi Yamamoto
- Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Junichi Nishimura
- Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Hiroshi Wada
- Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Hidenori Takahashi
- Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Masayoshi Yasui
- Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Takeshi Omori
- Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Masayuki Ohue
- Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Masahiko Yano
- Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan
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28
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Pinto E, Nardi MT, Marchi R, Cavallin F, Alfieri R, Saadeh L, Cagol M, Baldan I, Saraceni E, Parotto M, Baratto F, Caberlotto C, Vianello A, Castoro C, Scarpa M. QOLEC2: a randomized controlled trial on nutritional and respiratory counseling after esophagectomy for cancer. Support Care Cancer 2020; 29:1025-1033. [PMID: 32572611 PMCID: PMC7307937 DOI: 10.1007/s00520-020-05573-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 06/11/2020] [Indexed: 01/18/2023]
Abstract
Background Esophagectomy for cancer strongly impairs quality of life. The aim of this trial was to evaluate the effect of the nutritional and respiratory counseling on postoperative quality of life. Methods At hospital discharge, patients were randomized into four groups receiving respectively: nutritional and respiratory counseling, nutritional counseling alone, respiratory counseling alone, or standard care. The main endpoint was the impairment in quality of life in the first month after surgery. Linear mixed effect models were estimated to assess mean score differences (MDs) in quality of life scores. Results Patients receiving nutritional counseling reported less appetite loss (MD − 17.7, 95% CI − 32.2 to −3.3) than those not receiving nutritional counseling at 1 month after surgery. Dyspnea was similar between patients receiving vs. those not receiving respiratory counseling (MD − 3.1, 95% CI − 10.8 to 4.6). Global quality of life was clinically similar between patients receiving vs. those not receiving nutritional counseling over time (MD 0.9, 95% CI − 5.5 to 7.3), as well as in patients receiving vs. those not receiving respiratory counseling over time (MD 0.7, 95% CI − 5.9 to 7.2). Conclusions Intensive postoperative care does not affect global quality of life even if nutritional counseling reduced appetite loss. Electronic supplementary material The online version of this article (10.1007/s00520-020-05573-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Eleonora Pinto
- Oesophageal and Digestive Tract Surgical Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Maria Teresa Nardi
- Nutritional Support Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Rita Marchi
- Respiratory Intensive Care Unit, Azienda Ospedaliera di Padova, Padua, Italy
| | - Francesco Cavallin
- Oesophageal and Digestive Tract Surgical Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Rita Alfieri
- Oesophageal and Digestive Tract Surgical Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Luca Saadeh
- Oesophageal and Digestive Tract Surgical Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Matteo Cagol
- Oesophageal and Digestive Tract Surgical Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Ilaria Baldan
- Nutritional Support Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | | | - Matteo Parotto
- Intensive Care Unit, Toronto General Hospital, Toronto, Ontario, Canada
| | - Fabio Baratto
- Intensive Care Unit (ISTAR 2), Azienda Ospedaliera di Padova, Padua, Italy
| | - Cristina Caberlotto
- Oesophageal and Digestive Tract Surgical Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Andrea Vianello
- Respiratory Intensive Care Unit, Azienda Ospedaliera di Padova, Padua, Italy
| | - Carlo Castoro
- Department. of Upper GI Surgery, Humanitas Research Hospital-Humanitas University, Rozzano, Italy
| | - Marco Scarpa
- General Surgery Unit, Azienda Ospedaliera di Padova, Padua, Italy.
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29
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Klevebro F, Johar A, Lagergren P. Impact of co-morbidities on health-related quality of life 10 years after surgical treatment of oesophageal cancer. BJS Open 2020; 4:601-604. [PMID: 32472656 PMCID: PMC7397362 DOI: 10.1002/bjs5.50303] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 05/04/2020] [Indexed: 11/14/2022] Open
Abstract
Background Oesophagectomy for cancer is associated with long‐term decreased health‐related quality of life (HRQoL). The aim of this study was to evaluate the effect of co‐morbidities on HRQoL among survivors of oesophageal or gastro‐oesophageal junctional cancers after 10 years or
more. Methods The study included a prospectively collected, population‐based cohort, comprising all patients who had surgery for oesophageal or gastro‐oesophageal junctional cancer in Sweden in 2001–2005 with follow‐up until 31 December 2016. All data regarding patient and tumour characteristics, treatment details and HRQoL were collected using a prospectively created database. Multivariable ANCOVA regression models, adjusting for age, sex, tumour histology, stage and surgical technique, were used to calculate adjusted mean scores with 95 per cent confidence intervals for all HRQoL outcomes. Results A total of 92 survivors (88·5 per cent) responded to the questionnaires. Patients were stratified in two groups according to whether they reported a low or high impact of co‐morbidities on general health. Patients in the high‐impact group had clinically significantly decreased HRQoL and an increased level of symptoms, but differences between these two groups were not statistically significant. Conclusion Co‐morbidities with high impact on general health still contribute to impaired HRQoL 10 years after oesophagectomy for cancer.
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Affiliation(s)
- F Klevebro
- Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - A Johar
- Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - P Lagergren
- Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.,Department of Surgery and Cancer, Imperial College London, London, UK
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30
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Jezerskyte E, Saadeh LM, Hagens ERC, Sprangers MAG, Noteboom L, van Laarhoven HWM, Eshuis WJ, Hulshof MCCM, van Berge Henegouwen MI, Gisbertz SS. Long-term health-related quality of life after McKeown and Ivor Lewis esophagectomy for esophageal carcinoma. Dis Esophagus 2020; 33:5842244. [PMID: 32444879 PMCID: PMC7672202 DOI: 10.1093/dote/doaa022] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 02/19/2020] [Accepted: 03/30/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Both cervical (McKeown) and intrathoracic (Ivor Lewis) anastomosis of transthoracic esophagectomy are surgical procedures that can be performed for distal esophageal or gastro-esophageal junction (GEJ) cancer. The purpose of this study was to investigate the long-term health-related quality of life (HR-QoL) after McKeown and Ivor Lewis esophagectomy in a tertiary referral center. METHODS Disease-free patients >1 year following a McKeown or an Ivor Lewis esophagectomy with a two-field lymphadenectomy for a distal or GEJ carcinoma visiting the outpatient clinic between 2014 and 2018 were asked to complete the EORTC QLQ-C30 and EORTC QLQ-OG25 questionnaires. HR-QoL was investigated in both groups. RESULTS A total of 89 patients were included after McKeown and 115 after Ivor Lewis esophagectomy. Median follow-up was 2.4 years (IQR 1.7-3.6). Patients after McKeown esophagectomy reported more problems with 'eating with others' compared to patients after Ivor Lewis esophagectomy (mean scores: 49.9 vs. 38.8). This difference was both clinically relevant and significant after correction for multiple testing (β = 11.1, 95% CI 3.105-19.127, P = 0.042). Patients in both groups reported a poorer HR-QoL (≥10 points) than the general population with respect to nausea and vomiting, dyspnea, appetite loss, financial difficulties, problems with eating, reflux, eating with others, choked when swallowing, trouble with coughing, and weight loss. CONCLUSION Long-term HR-QoL of disease-free patients following a McKeown or Ivor Lewis esophagectomy for a distal or GEJ carcinoma is largely comparable. Irrespective of the surgical technique, patients' HR-QoL following esophagectomy is compromised. When given the choice, patients should be informed that after a McKeown esophagectomy more problems while eating with others can occur.
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Affiliation(s)
- E Jezerskyte
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - L M Saadeh
- General Surgery Unit, University Hospital of Padua, Padua, Italy
| | - E R C Hagens
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - M A G Sprangers
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - L Noteboom
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - H W M van Laarhoven
- Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - W J Eshuis
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - M C C M Hulshof
- Department of Radiotherapy, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - M I van Berge Henegouwen
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - S S Gisbertz
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands,Address correspondence to: Dr S.S. Gisbertz, Department of Surgery, Amsterdam UMC, location AMC, PO Box 22660, 1100 DD Amsterdam, The Netherlands.
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Abstract
With increasing survival after esophagectomy for cancer, a growing number of individuals living with the functional results of a surgically altered anatomy calls for attention to the effects of delayed gastric conduit emptying (DGCE) on health-related quality of life and nutritional impairment. We here give an overview of the currently available literature on DGCE, in terms of epidemiology, pathophysiology, diagnostics, prevention and treatment. Attention is given to controversies in the current literature and obstacles related to general applicability of study results, as well as knowledge gaps that may be the focus for future research initiatives. Finally, we propose that measures are taken to reach international expert agreement regarding diagnostic criteria and a symptom grading tool for DGCE, and that functional radiological methods are established for the diagnosis and severity grading of DGCE.
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Affiliation(s)
- Magnus Konradsson
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC) and Karolinska University Hospital, Stockholm, Sweden
| | - Magnus Nilsson
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC) and Karolinska University Hospital, Stockholm, Sweden
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Anandavadivelan P, Martin L, Djärv T, Johar A, Lagergren P. Nutrition Impact Symptoms Are Prognostic of Quality of Life and Mortality after Surgery for Oesophageal Cancer. Cancers (Basel) 2018; 10:cancers10090318. [PMID: 30205530 PMCID: PMC6162430 DOI: 10.3390/cancers10090318] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 08/28/2018] [Accepted: 09/04/2018] [Indexed: 01/03/2023] Open
Abstract
We aimed to clarify the influence of nutritional problems after surgery for oesophageal cancer on functional health related quality of life (HRQOL) and survival. A prospective nationwide cohort of oesophageal cancer patients operated 2001–2005 in Sweden with 6 months postoperative follow up was used. Nutritional problems were categorized as low/moderate/severe/very severe based on weight loss and nutrition impact symptoms. An ANCOVA model calculated mean score differences (MD) with 95% confidence intervals (CI) of global quality of life (QOL), social and physical function scores, stratified by preoperative body mass index (BMI) <25 and ≥25. A Cox proportional hazards model produced hazard ratios (HR) with 95% CI for overall 5-year survival. Of 358 patients, 196 (55%) had preoperative BMI ≥25. Very severe and severe nutritional problems were associated with worse HRQOL in both BMI groups. E.g. MD’s for global QOL among ‘very severe’ group was −29 (95% CI −39–−19) and −20 (95% CI −29–−11) for <25 and ≥25 BMI, respectively, compared to the ‘low’ group. Overall 5-year survival among ‘very severe’ and BMI ≥ 25 was worse; HR 4.6 (95% CI 1.4–15.6). Intense nutritional problems negatively impact postoperative HRQOL and combined with preoperative BMI ≥ 25 are associated with poorer 5-year overall survival representing a group needing greater clinical attention.
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Affiliation(s)
- Poorna Anandavadivelan
- Surgical Care Sciences, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, 17176 Stockholm, Sweden.
| | - Lena Martin
- Department of Biosciences and Nutrition, Karolinska Institutet, 171 76 Stockholm, Sweden.
- Function Area Clinical Nutrition, Karolinska University Hospital, 141 86 Stockholm, Sweden.
| | - Therese Djärv
- Department of Medicine, Solna, Karolinska Institutet, 171 76 Stockholm, Sweden.
| | - Asif Johar
- Surgical Care Sciences, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, 17176 Stockholm, Sweden.
| | - Pernilla Lagergren
- Surgical Care Sciences, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, 17176 Stockholm, Sweden.
- Department of Surgery and Cancer, Imperial College London, SW7 2AZ London, UK.
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Di Marco M, Rubbi I, Baldi A, Di Lorenzo R, Magnani D, Cremonini V, Sarli L, Artioli G, Ferri P. Evaluation of fatigue in patients with pancreatic cancer receiving chemotherapy treatment: a cross-sectional observational study. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:18-27. [PMID: 29644986 PMCID: PMC6357627 DOI: 10.23750/abm.v89i4-s.7063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 02/27/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM OF THE WORK Cancer-related fatigue (CRF) is one of the most common symptoms experienced by cancer patients (CPs) and negatively affects quality of life. Although CRF is frequently experienced, it is often underreported, underdiagnosed and undertreated. The objectives of this study were to evaluate the level of fatigue in patients with pancreatic cancer undergoing chemotherapy and to analyse its correlation with patients' demographic and clinical variables. METHODS A cross-sectional observational study was implemented in the Oncology Day Hospital of a Northern Italian hospital. A sample of 48 patients receiving chemotherapy were evaluated through the Brief Fatigue Inventory Italian version (BFI-I) between 1 May and 12 October 2016. Data were statistically analysed. RESULTS Most of our patients (94%) experienced fatigue. Women as well as patients with an age ≥65 years reported more fatigue. Anemia, pain and a weight loss of over 16 kg in the last 6 months were significantly related to the perception of fatigue. Regarding life habits, smoking was related to high global score of BFI-I. CONCLUSIONS In accordance with literature, our study suggests that fatigue is a frequent symptom influenced by many constitutional, clinical and environmental factors. Our results highlight the need for an early and regular evaluation of fatigue among cancer patients, in order to implement all those pharmacological and non-pharmacological interventions with proven efficacy in attenuating this symptom.
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Affiliation(s)
- Mariacristina Di Marco
- Department of Specialist, Diagnostic and Experimental Medicine, Sant'Orsola - Malpighi Hospital, University of Bologna, Bologna, Italy.
| | - Ivan Rubbi
- School of Nursing, University of Bologna, Bologna, Italy.
| | - Agnese Baldi
- School of Nursing, University of Bologna, Bologna, Italy.
| | - Rosaria Di Lorenzo
- Department of Mental Health, Local Health Authority (AUSL) of Modena, Modena, Italy.
| | - Daniela Magnani
- School of Nursing, Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy.
| | - Valeria Cremonini
- School of Nursing, ASL Romagna and University of Bologna, Bologna, Italy School of Nursing, Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy.
| | - Leopoldo Sarli
- Department of Medicine and Surgery, University of Parma, Parma, Italy.
| | - Giovanna Artioli
- Local Health Centre - Santa Maria Nuova Hospital Scientific Institute for Research, Hospitalization and Health Care, Reggio Emilia, Italy.
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