1
|
Miao Y, Nie X, He WW, Luo CY, Xia Y, Zhou AR, Wei SR, Wang CH, Fang Q, Peng L, Leng XF, Han YT, Luo L, Xie Q. Longitudinal patient-reported outcomes after minimally invasive McKeown esophagectomy for patients with esophageal squamous cell carcinoma. Support Care Cancer 2024; 32:237. [PMID: 38509239 PMCID: PMC10954946 DOI: 10.1007/s00520-024-08428-z] [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: 09/13/2023] [Accepted: 03/08/2024] [Indexed: 03/22/2024]
Abstract
PURPOSE Surgery for esophageal squamous cell carcinoma (ESCC) is characterized by a poor prognosis and high complication rate, resulting in a heavy symptom burden and poor health-related quality of life (QOL). We evaluated longitudinal patient-reported outcomes (PROs) to analyze the correlations between symptoms and QOL and their changing characteristics during postoperative rehabilitation. METHODS We investigated patients with ESCC who underwent minimally invasive McKeown esophagectomy at Sichuan Cancer Hospital between April 2019 and December 2019. Longitudinal data of the clinical characteristics and PROs were collected. The MD Anderson Symptom Inventory and European Organization for Research and Treatment of Cancer (EORTC) QOL questionnaires were used to assess symptoms and QOL and compare the trajectories of PROs during the investigation. RESULTS A total of 244 patients with ESCC were enrolled in this study. Regarding QOL, role and emotional functions returned to baseline at 1 month after surgery, and cognitive and social functions returned to baseline at 3 months after surgery. However, physical function and global QOL did not return to baseline at 1 year after surgery. At 7 days and 1, 3, 6, and 12 months after surgery, the main symptoms of the patients were negatively correlated with physical, role, emotional, cognitive, and social functions and the overall health status (P < 0.05). CONCLUSION Patients with ESCC experience reduced health-related QOL and persisting symptoms after minimally invasive McKeown esophagectomy, but a recovery trend was observed within 1 month. The long-term QOL after esophagectomy is acceptable.
Collapse
Affiliation(s)
- Yan Miao
- Department of Thoracic Surgery, Sichuan Cancer Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, Sichuan, 610041, People's Republic of China
| | - Xin Nie
- Department of Thoracic Surgery, Sichuan Cancer Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, Sichuan, 610041, People's Republic of China
| | - Wen-Wu He
- Department of Thoracic Surgery, Sichuan Cancer Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, Sichuan, 610041, People's Republic of China
| | - Chun-Yan Luo
- Department of Thoracic Surgery, Sichuan Cancer Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, Sichuan, 610041, People's Republic of China
| | - Yan Xia
- Department of Thoracic Surgery, Sichuan Cancer Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, Sichuan, 610041, People's Republic of China
| | - Ao-Ru Zhou
- Department of Thoracic Surgery, Sichuan Cancer Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, Sichuan, 610041, People's Republic of China
| | - Si-Rui Wei
- Department of Thoracic Surgery, Sichuan Cancer Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, Sichuan, 610041, People's Republic of China
| | - Cheng-Hao Wang
- Department of Thoracic Surgery, Sichuan Cancer Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, Sichuan, 610041, People's Republic of China
| | - Qiang Fang
- Department of Thoracic Surgery, Sichuan Cancer Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, Sichuan, 610041, People's Republic of China
| | - Lin Peng
- Department of Thoracic Surgery, Sichuan Cancer Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, Sichuan, 610041, People's Republic of China
| | - Xue-Feng Leng
- Department of Thoracic Surgery, Sichuan Cancer Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, Sichuan, 610041, People's Republic of China
| | - Yong-Tao Han
- Department of Thoracic Surgery, Sichuan Cancer Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, Sichuan, 610041, People's Republic of China
| | - Lei Luo
- Department of Thoracic Surgery, Sichuan Cancer Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, Sichuan, 610041, People's Republic of China.
| | - Qin Xie
- Department of Thoracic Surgery, Sichuan Cancer Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, Sichuan, 610041, People's Republic of China.
| |
Collapse
|
2
|
Feyisa JD, Addissie A, Kantelhardt EJ, Zingeta GT, Mideksa HS, GebreLibanos H, Mengesha T, Assefa M. Health-related quality of life assessment among patients with oesophageal cancer at Tikur Anbessa Specialised Tertiary Hospital in Ethiopia: a cross sectional study. Ecancermedicalscience 2024; 18:1656. [PMID: 38425768 PMCID: PMC10901634 DOI: 10.3332/ecancer.2024.1656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Indexed: 03/02/2024] Open
Abstract
Background In low-income countries, oesophageal cancer often presents at an advanced stage, leaving patients with limited curative treatment options. Furthermore, palliative treatments such as oesophageal stents or brachytherapy are lacking. This has a detrimental effect on their quality of life. In this study, we investigated the health-related quality of life of patients with oesophageal cancer at a tertiary hospital in Ethiopia. Methods This cross-sectional study was conducted at Tikur Anbessa Specialised Tertiary Hospital in Ethiopia. The validated Amharic version of the questionnaire of the European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire Cancer 30 (EORTC QLQ C-30) and the oesophageal cancer disease-specific questionnaire QLQ-OES18 were used to assess the quality of life of each patient. Results The overall mean score for the EORTC QLQ C-30 was 35.43 (SD 18.04). The mean scores for the functional scales revealed that cognitive function was the highest, whereas role function was the lowest. The symptom scale results showed the highest score for pain and the lowest for diarrhoea. Dysphagia, choking, role functioning and financial difficulty correlated with the quality of life of patients with oesophageal cancer. Conclusion Dysphagia, choking, role functioning and financial difficulty are important factors that affect the quality of life of patients with oesophageal cancer patients. Increasing the availability of palliative treatments for dysphagia to improve the quality of life in patients with oesophageal cancer is recommended.
Collapse
Affiliation(s)
- Jilcha Diribi Feyisa
- Department of Oncology, Saint Paul’s Hospital Millennium Medical College, Addis Ababa 1271, Ethiopia
- Department of Radiation Oncology and Applied Sciences, Dartmouth Cancer Center, Lebanon, NH 03756, USA
- https://orcid.org/0000-0002-5344-5340
| | - Adamu Addissie
- Global Health Working Group, Institute for Medical Epidemiology, Biometrics, and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale) 53170, Germany
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa 9086, Ethiopia
| | - Eva Johanna Kantelhardt
- Global Health Working Group, Institute for Medical Epidemiology, Biometrics, and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale) 53170, Germany
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale) 53170, Germany
| | - Girum Tessema Zingeta
- Department of Oncology, School of Medicine, Addis Ababa University, Addis Ababa 9086, Ethiopia
- https://orcid.org/0000-0003-0272-8460
| | - Hiwot Saboksa Mideksa
- Department of Oncology, School of Medicine, Addis Ababa University, Addis Ababa 9086, Ethiopia
| | - Helen GebreLibanos
- Department of Epidemiology, School of Public Health, Debre Birhan University, Debre Birhan 445, Ethiopia
| | - Tariku Mengesha
- Department of Research, Saint Peter’s Specialised Hospital, Addis Ababa 21494, Ethiopia
| | - Mathewos Assefa
- Department of Oncology, School of Medicine, Addis Ababa University, Addis Ababa 9086, Ethiopia
| |
Collapse
|
3
|
Wang X, Wang C, Han W, Sun J, Hui Z, Lei S, Wu H, Liu X. Global status of research on gastrointestinal cancer patients' quality of life: A bibliometric and visual analysis from 2003 to 2023. Heliyon 2024; 10:e23377. [PMID: 38148818 PMCID: PMC10750154 DOI: 10.1016/j.heliyon.2023.e23377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 11/24/2023] [Accepted: 12/01/2023] [Indexed: 12/28/2023] Open
Abstract
Objective To analyze the current research status, hotspots, and frontiers in the field of Gastrointestinal (GI) cancer and quality of life (QoL) through the bibliometrics method, and to provide references and guidance for future research. Methods Literature related to GI cancer and QoL from April 1, 2003 to March 31, 2023 was retrieved from the Web of Science Core Collection database. CiteSpace 6.2.R1 was performed for collaboration analysis, keyword co-occurrence analysis, and document co-citation analysis. Results A total of 1224 publications were included in this study. There has been a significant increase in the number of publications in this field over the past two decades. The United States, the Karolinska Institute and the University of Amsterdam, and Pernilla Lagergren are the most prolific country, institution, and author, respectively. The links between most of the research constituents were relatively thin (centrality <0.1). The keyword analysis indicates that the benefits of physical activity on QoL, the levels of psychological distress and its relationship with QoL, as well as the development and validation of QoL measurement tools have been the research hotspots. Open-label/double-blind trials exploring therapeutic interventions and more targeted new drugs or more effective drug combinations, and longitudinal studies determining the direction of the association between psychological distress and QoL at different time points, may be emerging trends in this field. Conclusion The cooperation among countries, institutions, and authors in this field should be strengthened. In addition, the health benefits of light physical activity, interventions for QoL, trajectory and direction of the relationship between psychological distress and QoL may be the focus of future research.
Collapse
Affiliation(s)
- Xiaoqin Wang
- Department of Pediatrics, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
- School of Nursing, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Caihua Wang
- School of Nursing, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Wenjin Han
- School of Nursing, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Jiaru Sun
- School of Nursing, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Zhaozhao Hui
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Shuangyan Lei
- Department of Radiotherapy, Shaanxi Cancer Hospital, Xi'an, China
| | - Huili Wu
- Department of Oncology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xiaohong Liu
- Department of Pediatrics, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| |
Collapse
|
4
|
Harada T, Tsuji T, Yanagisawa T, Ueno J, Hijikata N, Ishikawa A, Hiroshige K, Kotani D, Kojima T, Fujita T. Skeletal muscle mass recovery after oesophagectomy and neoadjuvant chemotherapy in oesophageal cancer: retrospective cohort study. BMJ Support Palliat Care 2023:spcare-2023-004245. [PMID: 37130721 DOI: 10.1136/spcare-2023-004245] [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: 02/27/2023] [Accepted: 04/18/2023] [Indexed: 05/04/2023]
Abstract
OBJECTIVE Skeletal muscle mass (SMM) is an important biomarker for prognosis and health in older patients with cancer. Limited information is available on the recovery course of SMM after oesophagectomy following neoadjuvant chemotherapy (NAC) in older patients. This study was performed to investigate the recovery course of SMM after oesophagectomy following NAC and the preoperative predictors of delayed recovery in older patients with locally advanced oesophageal cancer (LAEC). METHODS This single-centre retrospective cohort study involved older (≥65 years) and non-older (<65 years) patients with LAEC who underwent oesophagectomy following NAC. The SMM index (SMI) was calculated using CT images. One-way analysis of variance and multivariate logistic regression analysis were performed. RESULTS In total, 110 older patients and 57 non-older patients were analysed. Loss of the SMI after NAC to 12 months postoperatively was significantly greater in older patients than in non-older patients (p<0.01). The significant preoperative predictor of delayed recovery of the SMI 12 months after surgery was loss of the SMI during NAC in older patients (per 1%: adjusted OR 1.249; 95% CI 1.131 to 1.403; p<0.001), but not in non-older patients (per 1%: OR 1.074; 95% CI 0.988 to 1.179; p=0.108). CONCLUSIONS There is an especially large unmet need for preventing the long-term sequelae of SMM loss in older patients with LAEC after oesophagectomy following NAC. In older patients, loss of SMM during NAC is an especially useful biomarker for prescribing postoperative rehabilitation to prevent postoperative loss of SMM.
Collapse
Affiliation(s)
- Tsuyoshi Harada
- Department of Rehabilitation Medicine, National Cancer Center-Hospital East, Kashiwa, Japan
- Department of Rehabilitation Medicine, Keio University School of Medicine Graduate School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Tetsuya Tsuji
- Department of Rehabilitation Medicine, National Cancer Center-Hospital East, Kashiwa, Japan
- Department of Rehabilitation Medicine, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Takumi Yanagisawa
- Department of Rehabilitation Medicine, National Cancer Center-Hospital East, Kashiwa, Japan
- Department of Rehabilitation Medicine, Keio University School of Medicine Graduate School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Junya Ueno
- Department of Rehabilitation Medicine, National Cancer Center-Hospital East, Kashiwa, Japan
| | - Nanako Hijikata
- Department of Rehabilitation Medicine, National Cancer Center-Hospital East, Kashiwa, Japan
| | - Aiko Ishikawa
- Department of Rehabilitation Medicine, National Cancer Center-Hospital East, Kashiwa, Japan
- Department of Rehabilitation Medicine, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Keiichi Hiroshige
- Department of Physical Therapy, Kyushu Nutrition Welfare University, Kitakyushu, Fukuoka, Japan
| | - Daisuke Kotani
- Department of Gastrointestinal Oncology, National Cancer Center-Hospital East, Kashiwa, Chiba, Japan
| | - Takashi Kojima
- Department of Gastrointestinal Oncology, National Cancer Center-Hospital East, Kashiwa, Chiba, Japan
| | - Takeo Fujita
- Department of Esophageal Surgery, National Cancer Center-Hospital East, Kashiwa, Chiba, Japan
| |
Collapse
|
5
|
Schuring N, Markar SR, Hagens ERC, Jezerskyte E, Sprangers MAG, Lagergren P, Johar A, Gisbertz SS, van Berge Henegouwen MI. Health-related quality of life following neoadjuvant chemoradiotherapy versus perioperative chemotherapy and esophagectomy for esophageal cancer: a European multicenter study. Dis Esophagus 2022; 36:6761045. [PMID: 36241253 DOI: 10.1093/dote/doac069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 09/08/2022] [Indexed: 12/11/2022]
Abstract
Curative treatment for locally advanced esophageal cancer consists of (neo)adjuvant treatment followed by esophagectomy. Both neoadjuvant chemoradiotherapy and perioperative chemotherapy improve the 5-year overall survival rate compared with surgery alone. However, it is unknown whether these treatment strategies are associated with differences in long-term health-related quality of life (HRQL). The aim of this study is to compare long-term HRQL in patients after esophagectomy treated with neoadjuvant chemoradiotherapy or perioperative chemotherapy. Disease-free cancer patients having undergone esophagectomy and (neo)adjuvant treatment in one of the participating lasting symptoms after esophageal resection (LASER) study centers between 2010 and 2016, were identified from the LASER study dataset. Included patients completed the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTC QLQ-C30), EORTC QLQ-OG25, and LASER questionnaires at least 1 year after the completion of treatment. Long-term HRQL was compared between patients treated with neoadjuvant chemoradiotherapy or perioperative chemotherapy, using univariable and multivariable regression and presented as differences in mean score. Among the 565 included patients, 349 (61.8%) received neoadjuvant chemoradiotherapy, and 216 (38.2%) perioperative chemotherapy. Patients treated with perioperative chemotherapy reported more symptomatology for diarrhea (difference in means 5.93), reflux (difference in means 7.40), and odynophagia (difference in means 4.66). The differences did not exceed the 10 points to be of clinical relevance. No significant differences for the LASER key symptoms were observed. The observed differences in long-term HRQL are in favor of patients treated with neoadjuvant chemoradiotherapy compared with patients treated with perioperative chemotherapy; however, the differences were small. Patients need to be informed about long-term HRQL when considering allocation of (neo)adjuvant treatment.
Collapse
Affiliation(s)
- N Schuring
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands.,Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
| | - S R Markar
- Nuffield Department of Surgery, University of Oxford, Oxford, UK.,Department of Molecular Medicine & Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - E R C Hagens
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands.,Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
| | - E Jezerskyte
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands.,Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
| | - M A G Sprangers
- Department of Medical Psychology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - P Lagergren
- Department of Molecular Medicine & Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - A Johar
- Department of Molecular Medicine & Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - S 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
| | - M I van Berge Henegouwen
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands.,Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
| | | |
Collapse
|
6
|
Williams A, Cunningham A, Hutchings H, Harris DA, Evans MD, Harji D. Quality of internet information to aid patient decision making in locally advanced and recurrent rectal cancer. Surgeon 2022; 20:e382-e391. [PMID: 35033455 DOI: 10.1016/j.surge.2021.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/25/2021] [Accepted: 12/16/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND To review whether online decision aids are available for patients contemplating pelvic exenteration (PE) for locally advanced and recurrent rectal cancer (LARC and LRRC). METHODS A grey literature review was carried out using the Google Search™ engine undertaken using a predefined search strategy (PROSPERO database CRD42019122933). Written health information was assessed using the DISCERN criteria and International Patient Decision Aids Standards (IPDAS) with readability content assessed using the Flesch-Kincaid reading ease test and Flesch-Kincaid grade level score. RESULTS Google search yielded 27, 782, 200 results for the predefined search criteria. 131 sources were screened resulting in the analysis of 6 sources. No sources were identified as a decision aid according to the IPDAS criteria. All sources provided an acceptable quality of written health information, scoring a global score of 3 for the DISCERN written assessment. The median Flesch-Kincaid reading ease was 50.85 (32.5-80.8) equating to a reading age of 15-18 years and the median Flesch-Kincaid grade level score was 7.65 (range 3-9.7), which equates to a reading age of 13-14. CONCLUSIONS This study has found that there is a paucity of online information for patients contemplating PE. Sources that are available are aimed at a high health literate patient. Given the considerable morbidity associated with PE surgery there is a need for high quality relevant information in this area. A PDA should be developed to improve decision making and ultimately improve patient experience.
Collapse
Affiliation(s)
- A Williams
- Department of Surgery, Swansea Bay University Health Board, Singleton Hospital, Swansea, SA2 8QA, UK; Swansea University Medical School, Institute of Life Science 2, Swansea, SA2 8QA, UK.
| | - A Cunningham
- Department of Surgery, Swansea Bay University Health Board, Singleton Hospital, Swansea, SA2 8QA, UK; Swansea University Medical School, Institute of Life Science 2, Swansea, SA2 8QA, UK.
| | - H Hutchings
- Swansea University Medical School, Institute of Life Science 2, Swansea, SA2 8QA, UK.
| | - D A Harris
- Department of Surgery, Swansea Bay University Health Board, Singleton Hospital, Swansea, SA2 8QA, UK.
| | - M D Evans
- Department of Surgery, Swansea Bay University Health Board, Singleton Hospital, Swansea, SA2 8QA, UK.
| | - D Harji
- Population Health Sciences, University of Newcastle, Australia.
| |
Collapse
|
7
|
Shimada R, Yamasaki M, Tanaka K, Makino T, Doki Y, Umeshita K. Changes in the quality of life score following preoperative chemotherapy in elderly patients with esophageal cancer. Esophagus 2022; 19:113-119. [PMID: 34273018 DOI: 10.1007/s10388-021-00862-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 07/11/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Various functions in elderly patients with esophageal cancer deteriorate easily and their quality of life can be adversely affected by treatment. The age groups covered in previous studies are wide, and the impact on the elderly individuals is unknown. This study examined changes in quality of life scores after preoperative chemotherapy to clarify aspects of physical, psychological, and social quality of life in elderly patients with esophageal cancer. METHODS Thirty-six patients aged over 65 years, who were scheduled to undergo preoperative chemotherapy for esophageal cancer surgery, were enrolled. The survey questionnaire comprised the EORTC QLQ-C30 Japanese Language Version, EORTC QLQ-OES 18 Japanese Language Version, and G8. The surveys were conducted before chemotherapy (pre-CT) and after chemotherapy (post-CT). RESULTS In the functional scale of QLQ-C 30, physical functioning decreased significantly, while emotional functioning increased significantly post-CT (p = 0.021, p = 0.030, respectively). Global health status was not changed. In QLQ-OES18, the mean symptom scale score decreased significantly for dysphagia, trouble swallowing saliva, choking, eating, reflux, and pain post-CT (p = 0.014, p = 0.034, p = 0.033, p = 0.022, p = 0.026, p = 0.016, respectively). The mean G8 score decreased significantly from 11.7 to 10.7 (p = 0.022) post-CT, but the proportion of patients with dysfunction decreased. CONCLUSIONS Quality of life scores of elderly patients with esophageal cancer who received preoperative chemotherapy decreased in terms of physical function but improved in terms of esophageal cancer symptoms and mental function. Our results suggest that alleviation of symptoms contributed to the improvements in mental health.
Collapse
Affiliation(s)
- R Shimada
- Faculty of Health and Medical Sciences, Kyoto University of Advanced Science, 18 Gotanda-cho, Yamanouchi, Ukyo-ku, Kyoto, 615-8577, Japan.
| | - M Yamasaki
- Department of Surgery, Kansai Medical University, Osaka, Japan
| | - K Tanaka
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - T Makino
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Y Doki
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - K Umeshita
- Osaka International Cancer Institute, Osaka, Japan
| |
Collapse
|
8
|
Sunde B, Lindblad M, Malmström M, Hedberg J, Lagergren P, Nilsson M. Health-related quality of life one year after the diagnosis of oesophageal cancer: a population-based study from the Swedish National Registry for Oesophageal and Gastric Cancer. BMC Cancer 2021; 21:1277. [PMID: 34836512 PMCID: PMC8620917 DOI: 10.1186/s12885-021-09007-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 11/11/2021] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND Population-based patient reported outcome data in oesophageal cancer are rare. The main purpose of this study was to describe health-related quality of life (HRQOL) 1 year after the diagnosis of oesophageal cancer, comparing subgroups of curatively and palliatively managed patients. METHODS This is a nationwide population-based cohort study, based on the Swedish National Registry for Oesophageal and Gastric Cancer (NREV) with prospectively registered data, including HRQOL instruments from the European Organisation for Research and Treatment of Cancer including the core and disease specific questionnaires (EORTC QLQ-C30 and QLQ-OG25). Patients diagnosed with oesophageal cancer between 2009 and 2016 and with complete HRQOL data at 1 year follow-up were included. HRQOL of included patients was compared to a reference population matched by age and gender to to a previous cohort of unselected Swedish oesophageal cancer patients. Linear regression was performed to calculate mean scores with 95% confidence intervals (CI) and adjusted linear regression analysis was used to calculate mean score differences (MD) with 95% CI. RESULTS A total of 1156 patients were included. Functions and global health/quality of life were lower in both the curative and palliative cohorts compared to the reference population. Both curatively and palliatively managed patients reported a severe symptom burden compared to the reference population. Patients who underwent surgery reported more problems with diarrhoea compared to those treated with definitive chemoradiotherapy (dCRT) (MD -14; 95% CI - 20 to - 8). Dysphagia was more common in patiens treated with dCRT compared to surgically treated patients (MD 11; 95% CI 4 to 18). Those with palliative intent due to advanced tumour stage reported more problems with dysphagia compared to those with palliative intent due to frailty (MD -18; 95% CI - 33 to - 3). CONCLUSIONS One year after diagnosis both curative and palliative intent patients reported low function scores and severe symptoms. Dysphagia, choking, and other eating related problems were more pronounced in palliatively managed patients and in the curative intent patients treated with dCRT.
Collapse
Affiliation(s)
- Berit Sunde
- Division of Surgery, Department of Clinical Science Intervention and Technology, Karolinska Institutet and Department of Upper Abdominal Diseases, Karolinska University Hospital, SE-14186, Stockholm, Sweden.
| | - Mats Lindblad
- Division of Surgery, Department of Clinical Science Intervention and Technology, Karolinska Institutet and Department of Upper Abdominal Diseases, Karolinska University Hospital, SE-14186, Stockholm, Sweden
| | - Marlene Malmström
- Lund University, Department of Health Sciences and Department of surgery, Skane University Hospital, 221 85, Lund, Sweden
| | - Jakob Hedberg
- Department of Surgical Sciences, Uppsala University, 751 85, Uppsala, Sweden
| | - Pernilla Lagergren
- Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, 171 76, Stockholm, Sweden.,Department of Surgery and Cancer, Imperial College London, London, SW7 2AZ, UK
| | - Magnus Nilsson
- Division of Surgery, Department of Clinical Science Intervention and Technology, Karolinska Institutet and Department of Upper Abdominal Diseases, Karolinska University Hospital, SE-14186, Stockholm, Sweden
| |
Collapse
|
9
|
Allen SK, Brown V, White D, King D, Hunt J, Wainwright J, Emery A, Hodge E, Kehinde A, Prabhu P, Rockall TA, Preston SR, Sultan J. Multimodal Prehabilitation During Neoadjuvant Therapy Prior to Esophagogastric Cancer Resection: Effect on Cardiopulmonary Exercise Test Performance, Muscle Mass and Quality of Life-A Pilot Randomized Clinical Trial. Ann Surg Oncol 2021; 29:1839-1850. [PMID: 34725764 DOI: 10.1245/s10434-021-11002-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 09/28/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Neoadjuvant therapy reduces fitness, muscle mass, and quality of life (QOL). For patients undergoing chemotherapy and surgery for esophagogastric cancer, maintenance of fitness is paramount. This study investigated the effect of exercise and psychological prehabilitation on anaerobic threshold (AT) at cardiopulmonary exercise testing (CPET). Secondary endpoints included peak oxygen uptake (peak VO2), skeletal muscle mass, QOL, and neoadjuvant therapy completion. METHODS This parallel-arm randomized controlled trial assigned patients with locally advanced esophagogastric cancer to receive prehabilitation or usual care. The 15-week program comprised twice-weekly supervised exercises, thrice-weekly home exercises, and psychological coaching. CPET was performed at baseline, 2 weeks after neoadjuvant therapy, and 1 week preoperatively. Skeletal muscle cross-sectional area at L3 was analyzed on staging and restaging computed tomography. QOL questionnaires were completed at baseline, mid-neoadjuvant therapy, at restaging laparoscopy, and postoperatively at 2 weeks, 6 weeks and 6 months. RESULTS Fifty-four participants were randomized (prehabilitation group, n = 26; control group, n = 28). No difference in AT between groups was observed post-neoadjuvant therapy. Prehabilitation resulted in an attenuated peak VO2 decline {-0.4 [95% confidence interval (CI) -0.8 to 0.1] vs. -2.5 [95% CI -2.8 to -2.2] mL/kg/min; p = 0.022}, less muscle loss [-11.6 (95% CI -14.2 to -9.0) vs. -15.6 (95% CI -18.7 to -15.4) cm2/m2; p = 0.049], and improved QOL. More prehabilitation patients completed neoadjuvant therapy at full dose [prehabilitation group, 18 (75%) vs. control group, 13 (46%); p = 0.036]. No adverse events were reported. CONCLUSIONS This study has demonstrated some retention of cardiopulmonary fitness (peak VO2), muscle, and QOL in prehabilitation subjects. Further large-scale trials will help determine whether these promising findings translate into improved clinical and oncological outcomes. Trial Registration ClinicalTrials.gov NCT02950324.
Collapse
Affiliation(s)
- Sophie K Allen
- Department of General Surgery, The Royal Surrey NHS Foundation Trust Hospital, Guildford, UK.,Minimal Access Therapy Training Unit (MATTU), Guildford, UK
| | - Vanessa Brown
- Department of General Surgery, The Royal Surrey NHS Foundation Trust Hospital, Guildford, UK.,Minimal Access Therapy Training Unit (MATTU), Guildford, UK
| | - Daniel White
- Department of General Surgery, The Royal Surrey NHS Foundation Trust Hospital, Guildford, UK.,Minimal Access Therapy Training Unit (MATTU), Guildford, UK
| | - David King
- Faculty of Health and Medical Sciences, School of Biosciences and Medicine, University of Surrey, Guildford, UK
| | - Julie Hunt
- Faculty of Health and Medical Sciences, School of Biosciences and Medicine, University of Surrey, Guildford, UK
| | - Joe Wainwright
- Faculty of Health and Medical Sciences, School of Biosciences and Medicine, University of Surrey, Guildford, UK
| | - Annabelle Emery
- Faculty of Health and Medical Sciences, School of Biosciences and Medicine, University of Surrey, Guildford, UK
| | - Emily Hodge
- The Fountain Centre, St Luke's Cancer Centre, Guildford, UK
| | - Aga Kehinde
- The Fountain Centre, St Luke's Cancer Centre, Guildford, UK
| | - Pradeep Prabhu
- Department of Anaesthetics, The Royal Surrey NHS Foundation Trust Hospital, Guildford, UK
| | - Timothy A Rockall
- Department of General Surgery, The Royal Surrey NHS Foundation Trust Hospital, Guildford, UK.,Minimal Access Therapy Training Unit (MATTU), Guildford, UK
| | - Shaun R Preston
- Department of General Surgery, The Royal Surrey NHS Foundation Trust Hospital, Guildford, UK
| | - Javed Sultan
- Department of General Surgery, The Royal Surrey NHS Foundation Trust Hospital, Guildford, UK.
| |
Collapse
|
10
|
Kennedy SA, Annett SL, Dunne MR, Boland F, O'Neill LM, Guinan EM, Doyle SL, Foley EK, Elliott JA, Murphy CF, Bennett AE, Carey M, Hillary D, Robson T, Reynolds JV, Hussey J, O'Sullivan J. Effect of the Rehabilitation Program, ReStOre, on Serum Biomarkers in a Randomized Control Trial of Esophagogastric Cancer Survivors. Front Oncol 2021; 11:669078. [PMID: 34604026 PMCID: PMC8479183 DOI: 10.3389/fonc.2021.669078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 08/17/2021] [Indexed: 11/24/2022] Open
Abstract
Background The Rehabilitation Strategies Following Esophagogastric cancer (ReStOre) randomized control trial demonstrated a significant improvement in cardiorespiratory fitness of esophagogastric cancer survivors. This follow-up, exploratory study analyzed the biological effect of exercise intervention on levels of 55 serum proteins, encompassing mediators of angiogenesis, inflammation, and vascular injury, from participants on the ReStOre trial. Methods Patients >6 months disease free from esophagogastric cancer were randomized to usual care or the 12-week ReStOre program (exercise training, dietary counselling, and multidisciplinary education). Serum was collected at baseline (T0), post-intervention (T1), and at 3-month follow up (T2). Serum biomarkers were quantified by enzyme-linked immunosorbent assay (ELISA). Results Thirty-seven patients participated in this study; 17 in the control arm and 20 in the intervention arm. Exercise intervention resulted in significant alterations in the level of expression of serum IP-10 (mean difference (MD): 38.02 (95% CI: 0.69 to 75.35)), IL-27 (MD: 249.48 (95% CI: 22.43 to 476.53)), and the vascular injury biomarkers, ICAM-1 (MD: 1.05 (95% CI: 1.07 to 1.66)), and VCAM-1 (MD: 1.51 (95% CI: 1.04 to 2.14)) at T1. A significant increase in eotaxin-3 (MD: 2.59 (95% CI: 0.23 to 4.96)), IL-15 (MD: 0.27 (95% CI: 0 to 0.54)) and decrease in bFGF (MD: 1.62 (95% CI: -2.99 to 0.26)) expression was observed between control and intervention cohorts at T2 (p<0.05). Conclusions Exercise intervention significantly altered the expression of a number of serum biomarkers in disease-free patients who had prior treatment for esophagogastric cancer. Impact Exercise rehabilitation causes a significant biological effect on serum biomarkers in esophagogastric cancer survivors. Clinical Trial Registration ClinicalTrials.gov (NCT03314311).
Collapse
Affiliation(s)
- Susan A Kennedy
- Trinity St. James's Cancer Institute, Trinity Translational Medicine Institute, Department of Surgery, St. James's Hospital, Trinity College Dublin, Dublin, Ireland
| | - Stephanie L Annett
- School of Pharmacy and Biomolecular Science, Royal College of Surgeons Ireland, Dublin, Ireland
| | - Margaret R Dunne
- Trinity St. James's Cancer Institute, Trinity Translational Medicine Institute, Department of Surgery, St. James's Hospital, Trinity College Dublin, Dublin, Ireland
| | - Fiona Boland
- Data Science Centre, Royal College of Surgeons Ireland, Dublin, Ireland
| | - Linda M O'Neill
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Emer M Guinan
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Suzanne L Doyle
- School of Biological Sciences, Dublin Institute of Technology, Dublin, Ireland
| | - Emma K Foley
- Trinity St. James's Cancer Institute, Trinity Translational Medicine Institute, Department of Surgery, St. James's Hospital, Trinity College Dublin, Dublin, Ireland
| | - Jessie A Elliott
- Trinity St. James's Cancer Institute, Trinity Translational Medicine Institute, Department of Surgery, St. James's Hospital, Trinity College Dublin, Dublin, Ireland
| | - Conor F Murphy
- Trinity St. James's Cancer Institute, Trinity Translational Medicine Institute, Department of Surgery, St. James's Hospital, Trinity College Dublin, Dublin, Ireland
| | - Annemarie E Bennett
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Michelle Carey
- School of Mathematics & Statistics, University College Dublin, Dublin, Ireland
| | - Daniel Hillary
- School of Mathematics & Statistics, University College Dublin, Dublin, Ireland
| | - Tracy Robson
- School of Pharmacy and Biomolecular Science, Royal College of Surgeons Ireland, Dublin, Ireland
| | - John V Reynolds
- Trinity St. James's Cancer Institute, Trinity Translational Medicine Institute, Department of Surgery, St. James's Hospital, Trinity College Dublin, Dublin, Ireland
| | - Juliette Hussey
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Jacintha O'Sullivan
- Trinity St. James's Cancer Institute, Trinity Translational Medicine Institute, Department of Surgery, St. James's Hospital, Trinity College Dublin, Dublin, Ireland
| |
Collapse
|
11
|
Functional syndromes and symptom-orientated aftercare after esophagectomy. Langenbecks Arch Surg 2021; 406:2249-2261. [PMID: 34036407 PMCID: PMC8578083 DOI: 10.1007/s00423-021-02203-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 05/16/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Surgery is the cornerstone of esophageal cancer treatment but remains burdened with significant postoperative changes of gastrointestinal function and quality of life. PURPOSE The aim of this narrative review is to assess and summarize the current knowledge on postoperative functional syndromes and quality of life after esophagectomy for cancer, and to provide orientation for the reader in the challenging field of functional aftercare. CONCLUSIONS Post-esophagectomy syndromes include various conditions such as dysphagia, reflux, delayed gastric emptying, dumping syndrome, weight loss, and chronic diarrhea. Clinical pictures and individual expressions are highly variable and may be extremely distressing for those affected. Therefore, in addition to a mostly well-coordinated oncological follow-up, we strongly emphasize the need for regular monitoring of physical well-being and gastrointestinal function. The prerequisite for an effective functional aftercare covering the whole spectrum of postoperative syndromes is a comprehensive knowledge of the pathophysiological background. As functional conditions often require a complex diagnostic workup and long-term therapy, close interdisciplinary cooperation with radiologists, gastroenterologists, oncologists, and specialized nutritional counseling is imperative for successful management.
Collapse
|
12
|
Reddy CA, Tavakkoli A, Chen VL, Korsnes S, Bedi AO, Carrott PW, Chang AC, Lagisetty KH, Kwon RS, Elmunzer BJ, Orringer MB, Piraka C, Prabhu A, Reddy RM, Wamsteker E, Rubenstein JH. Long-Term Quality of Life Following Endoscopic Therapy Compared to Esophagectomy for Neoplastic Barrett's Esophagus. Dig Dis Sci 2021; 66:1580-1587. [PMID: 32519141 PMCID: PMC8327124 DOI: 10.1007/s10620-020-06377-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 05/30/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Endoscopic therapy (ET) and esophagectomy result in similar survival for Barrett's esophagus (BE) with high-grade dysplasia (HGD) or T1a esophageal adenocarcinoma (EAC), but the long-term quality of life (QOL) has not been compared. AIMS We aimed to compare long-term QOL between patients who had undergone ET versus esophagectomy. METHODS Patients were included if they underwent ET or esophagectomy at the University of Michigan since 2000 for the treatment of HGD or T1a EAC. Two validated survey QOL questionnaires were mailed to the patients. We compared QOL between and within groups (ET = 91, esophagectomy = 62), adjusting for covariates. RESULTS The median time since initial intervention was 6.8 years. Compared to esophagectomy, ET patients tended to be older, had a lower prevalence of EAC, and had a shorter duration since therapy. ET patients had worse adjusted physical and role functioning than esophagectomy patients. However, the adjusted odds ratio (OR) of having symptoms was significantly less with ET for diarrhea (0.287; 95% confidence interval [CI] = 0.114, 0.724), trouble eating (0.207; 0.0766, 0.562), choking (0.325; 0.119, 0.888), coughing (0.291; 0.114, 0.746), and speech difficulty (0.306; 0.0959, 0.978). Amongst the ET patients, we found that the number of therapy sessions and need for dilation were associated with worse outcomes. DISCUSSION Multiple measures of symptom status were better with ET compared to esophagectomy following treatment of BE with HGD or T1a EAC. We observed worse long-term physical and role functioning in ET patients which could reflect unmeasured baseline functional status rather than a causal effect of ET.
Collapse
Affiliation(s)
- Chanakyaram A Reddy
- Barrett's Esophagus Program, Division of Gastroenterology, University of Michigan, 1500 E Medical Center Dr., Ann Arbor, MI, 48109, USA.
| | - Anna Tavakkoli
- Division of Gastroenterology, UT Southwestern, Dallas, TX, USA
| | - Vincent L Chen
- Barrett's Esophagus Program, Division of Gastroenterology, University of Michigan, 1500 E Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Sheryl Korsnes
- Barrett's Esophagus Program, Division of Gastroenterology, University of Michigan, 1500 E Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Aarti Oza Bedi
- Barrett's Esophagus Program, Division of Gastroenterology, University of Michigan, 1500 E Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Philip W Carrott
- Division of Thoracic Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Andrew C Chang
- Section of Thoracic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Kiran H Lagisetty
- Section of Thoracic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Richard S Kwon
- Barrett's Esophagus Program, Division of Gastroenterology, University of Michigan, 1500 E Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - B Joseph Elmunzer
- Division of Gastroenterology, Medical University of South Carolina, Charleston, SC, USA
| | - Mark B Orringer
- Section of Thoracic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Cyrus Piraka
- Division of Gastroenterology, Henry Ford Health System, Detroit, MI, USA
| | - Anoop Prabhu
- Barrett's Esophagus Program, Division of Gastroenterology, University of Michigan, 1500 E Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Rishindra M Reddy
- Section of Thoracic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Erik Wamsteker
- Barrett's Esophagus Program, Division of Gastroenterology, University of Michigan, 1500 E Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Joel H Rubenstein
- Barrett's Esophagus Program, Division of Gastroenterology, University of Michigan, 1500 E Medical Center Dr., Ann Arbor, MI, 48109, USA
| |
Collapse
|
13
|
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 Quality of Life Following Transthoracic and Transhiatal Esophagectomy for Esophageal Cancer. J Gastrointest Surg 2021; 25:1657-1666. [PMID: 32909195 PMCID: PMC8275507 DOI: 10.1007/s11605-020-04783-4] [Citation(s) in RCA: 3] [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: 04/24/2020] [Accepted: 08/24/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND The impact of transthoracic (TTE) and transhiatal esophagectomy (THE) on long-term health-related quality of life (HR-QoL) in patients with distal esophageal or gastro-esophageal junction (GEJ) cancer has been studied with variable results. This study investigates long-term HR-QoL in patients having undergone TTE or THE. METHODS Disease-free patients after TTE or THE for distal esophageal or GEJ cancer with a follow-up > 2 years were included. Patients who visited the outpatient clinic of a tertiary referral center between 2014 and 2018 were asked to complete EORTC-QLQ-C30 and EORTC-QLQ-OG25 questionnaires. Uni- and multivariable linear regression analysis of HR-QoL was performed in all patients and in subgroups of minimally invasive esophagectomy and neoadjuvant therapy. RESULTS A total of 132 patients after TTE and 56 after THE were included. When compared with the general population, all patients reported worse HR-QoL in 'role functioning' and 'social functioning' and in a range of disease- and/or treatment-specific symptoms. The only significant difference between TTE and THE was a better HR-QoL score for "hair loss" following TTE (ß = 29.4,95%CI = -49.108 - -9.671, p = 0.016). Subgroup analysis of minimally invasively operated patients showed better scores in "physical functioning" following TTE (ß = 13.8,95%CI = 2.755-24.933, p = 0.030). No significant differences in HR-QoL were found between TTE and THE after neoadjuvant therapy. CONCLUSION Long-term HR-QoL is largely comparable in disease-free patients following TTE or THE for distal esophageal or GEJ cancer. If there were differences between the surgical groups, they were in favor of TTE. These findings may aid in preoperative counseling of patients with esophageal or GEJ cancer.
Collapse
Affiliation(s)
- E. Jezerskyte
- Amsterdam UMC, location AMC, Department of Surgery, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - L. M. Saadeh
- General Surgery Unit, University Hospital of Padua, Padua, Italy
| | - E. R. C. Hagens
- Amsterdam UMC, location AMC, Department of Surgery, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - M. A. G. Sprangers
- Amsterdam UMC, location AMC, Department of Medical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - L. Noteboom
- Amsterdam UMC, location AMC, Department of Surgery, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - H. W. M. van Laarhoven
- Amsterdam UMC, location AMC, Department of Medical Oncology, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - W. J. Eshuis
- Amsterdam UMC, location AMC, Department of Surgery, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - M. C. C. M. Hulshof
- Amsterdam UMC, location AMC, Department of Radiotherapy, University of Amsterdam, Amsterdam, The Netherlands
| | - M. I. van Berge Henegouwen
- Amsterdam UMC, location AMC, Department of Surgery, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - S. S. Gisbertz
- Amsterdam UMC, location AMC, Department of Surgery, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
14
|
Liu S, Lin Z, Lin J, Chen H, Xie Q, Rao W, Chen Y, Yu K, Hu Z. Health-related quality of life and treatment modality among esophageal squamous cell carcinoma survivors: A prospective study using time to deterioration model analysis. J Surg Oncol 2020; 123:156-163. [PMID: 33126290 DOI: 10.1002/jso.26264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 09/09/2020] [Accepted: 10/05/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND OBJECTIVES This study aimed to analyze the association between health-related quality of life and treatment modality among esophageal squamous cell carcinoma (ESCC) survivors. METHODS Patients completed the EORTC QLQ-C30 and EORTC QLQ-OES18 at baseline and follow-up. A time to deterioration model analysis was performed to compare longitudinal EORTC QLQ-C30/QLQ-OES18 data between surgery alone and surgery with adjuvant chemotherapy. RESULTS For EORTC QLQ-C30 scale, compared with surgery alone, significant delays in time to deterioration in role functioning (16.05 months vs. 15.00 months; p = .045), cognitive functioning (20.80 months vs. 16.26 months; p = .017), social functioning (19.09 months vs. 12.35 months; p = .001), and dyspnea (18.53 months vs. 14.62 months; p = .011) were observed for surgery with adjuvant chemotherapy. For QLQ-OES18 scale, compared with surgery alone, significant delays in time to deterioration in dysphagia (13.75 months vs. 8.16 months; p = .005), choking when swallowing (20.67 months vs. 15.08 months; p = .001), and dry mouth (21.78 months vs. 17.28 months; p = .039) were observed for surgery with adjuvant chemotherapy. CONCLUSIONS Patients who received postoperative chemotherapy had significant delay in time to deterioration in multiple ESCC-related symptoms, functions of EORTC QLQ-C30 and EORTC QLQ-OES18.
Collapse
Affiliation(s)
- Shuang Liu
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Zheng Lin
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Jianbo Lin
- Department of Thoracic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Huilin Chen
- Department of Radiation Oncology, Anxi County Hospital, Quanzhou, China
| | - Qianwen Xie
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Wenqing Rao
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Yuanmei Chen
- Department of Thoracic Surgery, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Kaili Yu
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Zhijian Hu
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou, China.,Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| |
Collapse
|
15
|
Patient experience and quality of life during neoadjuvant therapy for pancreatic cancer: a systematic review and study protocol. Support Care Cancer 2020; 29:3009-3016. [PMID: 33030596 DOI: 10.1007/s00520-020-05813-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/02/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE Neoadjuvant therapy (NT) is increasingly being offered to patients with pancreatic ductal adenocarcinoma (PDAC) prior to surgical resection. However, the experience and quality of life (QOL) of patients undergoing NT are poorly understood. METHODS A systematic review of the Cinahl, Embase, Medline, Pubmed, Scopus, and Web of Science databases was conducted to evaluate the available literature pertaining to the experience and QOL of patient's undergoing NT for PDAC. RESULTS Among 6041 articles screened, only six met criteria for full-text review including three prospective clinical trials of NT with QOL secondary endpoints. Overall, global QOL during or following NT did not significantly change from baseline. Pain scores seemed to improve during NT while the impact of NT on physical functioning varied across studies. No studies were identified evaluating other aspects of the patient experience. CONCLUSION Although NT appears to have a minor impact on the QOL of patients with PDAC, this systematic review identified significant evidence gaps in the literature. A protocol of a prospective observational cohort study utilizing a digital smartphone app that aims to evaluate the patient experience and longitudinal QOL of patients with PDAC undergoing NT is presented.
Collapse
|
16
|
Cho JH. Reflux Following Esophagectomy for Esophageal Cancer. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 53:217-221. [PMID: 32793455 PMCID: PMC7409890 DOI: 10.5090/kjtcs.2020.53.4.217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/09/2020] [Accepted: 07/11/2020] [Indexed: 02/04/2023]
Abstract
Gastroesophageal reflux is a common problem after gastroesophageal resection and reconstruction, despite the routine prescription of proton pump inhibitors (PPIs). Resection of the lower esophageal sphincter and excision of the vagus nerve are generally thought to be the main factors that interfere with gastric motor function. However, physiological studies of reflux symptoms after esophagectomy are still lacking. Gastroesophageal reflux occurs frequently after esophagectomy, but there is no known effective method to prevent it. Therefore, in order to manage gastroesophageal reflux after esophagectomy, strict lifestyle modifications and gastric acid suppression treatment such as PPIs are needed, and further clinical studies are required.
Collapse
Affiliation(s)
- Jong Ho Cho
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
17
|
van den Boorn HG, Stroes CI, Zwinderman AH, Eshuis WJ, Hulshof MCCM, van Etten-Jamaludin FS, Sprangers MAG, van Laarhoven HWM. Health-related quality of life in curatively-treated patients with esophageal or gastric cancer: A systematic review and meta-analysis. Crit Rev Oncol Hematol 2020; 154:103069. [PMID: 32818901 DOI: 10.1016/j.critrevonc.2020.103069] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 07/13/2020] [Accepted: 07/23/2020] [Indexed: 12/24/2022] Open
Abstract
Surgery and chemoradiotherapy can potentially cure esophageal and gastric cancer patients, although they may impact health-related quality of life (HRQoL). We aim to systemically review and meta-analyze literature to determine the effect of curative treatments on HRQoL in esophageal and gastric cancer.- A systematic search was performed identifying studies assessing HRQoL. Meta-analyses were performed on baseline and subsequent time-points.- From the 6067 articles retrieved, 49 studies were included (61 % low quality). Meta-analyses showed short-term HRQoL differences between esophageal cancer patients receiving definitive chemoradiotherapy (dCRT), neoadjuvant chemo(radio)therapy (nC(R)T), or surgery alone (p < 0.001), with better HRQoL with nC(R)T and surgery compared to dCRT. Over the course of 12 months, no HRQoL difference was identified between treatments in esophageal cancer (p = 0.633). Esophagectomy, but not gastrectomy, resulted in a clinically relevant decline in HRQoL. No long-term HRQoL differences were identified between curative treatments in esophageal and gastric cancer. More high-quality HRQoL studies are warranted.
Collapse
Affiliation(s)
- Héctor G van den Boorn
- Amsterdam UMC, University of Amsterdam, Department of Medical Oncology, Cancer Center Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Charlotte I Stroes
- Amsterdam UMC, University of Amsterdam, Department of Medical Oncology, Cancer Center Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Laboratory for Experimental Oncology and Radiobiology (LEXOR), Center for Experimental and Molecular Medicine (CEMM), Meibergdreef 9, Amsterdam, the Netherlands.
| | - Aeilko H Zwinderman
- Amsterdam UMC, University of Amsterdam, Department of Clinical Epidemiology and Biostatistics, Meibergdreef 9, Amsterdam, the Netherlands
| | - Wietse J Eshuis
- Amsterdam UMC, University of Amsterdam, Department of Surgery, Meibergdreef 9, Amsterdam, the Netherlands
| | - Maarten C C M Hulshof
- Amsterdam UMC, University of Amsterdam, Department of Radiotherapy, Meibergdreef 9, Amsterdam, the Netherlands
| | | | - Mirjam A G Sprangers
- Amsterdam UMC, University of Amsterdam, Department of Medical Psychology, Meibergdreef 9, Amsterdam, the Netherlands
| | - Hanneke W M van Laarhoven
- Amsterdam UMC, University of Amsterdam, Department of Medical Oncology, Cancer Center Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.
| |
Collapse
|
18
|
Richards HS, Blazeby JM, Portal A, Harding R, Reed T, Lander T, Chalmers KA, Carter R, Singhal R, Absolom K, Velikova G, Avery KNL. A real-time electronic symptom monitoring system for patients after discharge following surgery: a pilot study in cancer-related surgery. BMC Cancer 2020; 20:543. [PMID: 32522163 PMCID: PMC7285449 DOI: 10.1186/s12885-020-07027-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 06/01/2020] [Indexed: 11/17/2022] Open
Abstract
Background Advances in peri-operative care of surgical oncology patients result in shorter hospital stays. Earlier discharge may bring benefits, but complications can occur while patients are recovering at home. Electronic patient-reported outcome (ePRO) systems may enhance remote, real-time symptom monitoring and detection of complications after hospital discharge, thereby improving patient safety and outcomes. Evidence of the effectiveness of ePRO systems in surgical oncology is lacking. This pilot study evaluated the feasibility of a real-time electronic symptom monitoring system for patients after discharge following cancer-related upper gastrointestinal surgery. Methods A pilot study in two UK hospitals included patients who had undergone cancer-related upper gastrointestinal surgery. Participants completed the ePRO symptom-report at discharge, twice in the first week and weekly post-discharge. Symptom-report completeness, system actions, barriers to using the ePRO system and technical performance were examined. The ePRO surgery system is an online symptom-report that allows clinicians to view patient symptom-reports within hospital electronic health records and was developed as part of the eRAPID project. Clinically derived algorithms provide patients with tailored self-management advice, prompts to contact a clinician or automated clinician alerts depending on symptom severity. Interviews with participants and clinicians determined the acceptability of the ePRO system to support patients and their clinical management during recovery. Results Ninety-one patients were approached, of which 40 consented to participate (27 male, mean age 64 years). Symptom-report response rates were high (range 63–100%). Of 197 ePRO completions analysed, 76 (39%) triggered self-management advice, 72 (36%) trigged advice to contact a clinician, 9 (5%) triggered a clinician alert and 40 (20%) did not require advice. Participants found the ePRO system reassuring, providing timely information and advice relevant to supporting their recovery. Clinicians regarded the system as a useful adjunct to usual care, by signposting patients to seek appropriate help and enhancing their understanding of patients’ experiences during recovery. Conclusion Use of the ePRO system for the real-time, remote monitoring of symptoms in patients recovering from cancer-related upper gastrointestinal surgery is feasible and acceptable. A definitive randomised controlled trial is needed to evaluate the impact of the system on patients’ wellbeing after hospital discharge.
Collapse
Affiliation(s)
- H S Richards
- Medical Research Council ConDuCT-II Hub for Trials Methodology Research, National Institute for Health Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School, Population Health Sciences, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - J M Blazeby
- Medical Research Council ConDuCT-II Hub for Trials Methodology Research, National Institute for Health Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School, Population Health Sciences, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK.,Division of Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, BS2 8HW, UK
| | - A Portal
- Medical Research Council ConDuCT-II Hub for Trials Methodology Research, Bristol Centre for Surgical Research, Bristol Medical School, Population Health Sciences, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - R Harding
- Division of Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, BS2 8HW, UK
| | - T Reed
- Division of Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, BS2 8HW, UK
| | - T Lander
- Division of Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, BS2 8HW, UK
| | - K A Chalmers
- Medical Research Council ConDuCT-II Hub for Trials Methodology Research, National Institute for Health Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School, Population Health Sciences, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - R Carter
- Section of Patient-Centred Outcomes Research, Leeds Institute of Medical Research at St James's, University of Leeds, St James's Hospital, Leeds, LS9 7TF, UK
| | - R Singhal
- Queen Elizabeth Hospital Birmingham, Mindelson Way, Edgbaston, Birmingham, B15 2WB, UK
| | - K Absolom
- Section of Patient-Centred Outcomes Research, Leeds Institute of Medical Research at St James's, University of Leeds, St James's Hospital, Leeds, LS9 7TF, UK
| | - G Velikova
- Section of Patient-Centred Outcomes Research, Leeds Institute of Medical Research at St James's, University of Leeds, St James's Hospital, Leeds, LS9 7TF, UK
| | - K N L Avery
- Medical Research Council ConDuCT-II Hub for Trials Methodology Research, National Institute for Health Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School, Population Health Sciences, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK
| |
Collapse
|
19
|
Backemar L, Johar A, Wikman A, Zylstra J, Gossage J, Davies A, Lagergren J, Lagergren P. The Influence of Comorbidity on Health-Related Quality of Life After Esophageal Cancer Surgery. Ann Surg Oncol 2020; 27:2637-2645. [PMID: 32162078 PMCID: PMC7334248 DOI: 10.1245/s10434-020-08303-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Esophageal cancer surgery reduces patients' health-related quality of life (HRQoL). This study examined whether comorbidities influence HRQoL in these patients. METHODS This prospective cohort study included esophageal cancer patients having undergone curatively intended esophagectomy at St Thomas' Hospital London in 2011-2015. Clinical data were collected from patient reports and medical records. Well-validated cancer-specific and esophageal cancer-specific questionnaires (EORTC QLQ-C30 and QLQ-OG25) were used to assess HRQoL before and 6 months after esophagectomy. Number of comorbidities, American Society of Anesthesiologists physical status classification (ASA), and specific comorbidities were analyzed in relation to HRQoL aspects using multivariable linear regression models. Mean score differences with 95% confidence intervals were adjusted for potential confounders. RESULTS Among 136 patients, those with three or more comorbidities at the time of surgery had poorer global quality of life and physical function and more fatigue compared with those with no comorbidity. Patients with ASA III-IV reported more problems with the above HRQoL aspects and worse social function and pain compared with those with ASA I-II. Cardiac comorbidity was associated with worse global quality of life and dyspnea, while pulmonary comorbidities were related to coughing. Patients assessed both before and 6 months after surgery (n = 80) deteriorated in most HRQoL aspects regardless of comorbidity status, but patients with several comorbidities had worse physical function and fatigue and more trouble with coughing compared with those with fewer comorbidities. CONCLUSION Comorbidity appears to negatively influence HRQoL before esophagectomy, but appears not to severely impact 6-month recovery of HRQoL.
Collapse
Affiliation(s)
- Lovisa Backemar
- Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Asif Johar
- Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Wikman
- Reproductive Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Janine Zylstra
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.,School of Cancer and Pharmaceutical Sciences, Kings College, London, UK.,Upper Gastrointestinal Surgery, Guy's and St Thomas' NHS Trust, London, UK
| | - James Gossage
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.,School of Cancer and Pharmaceutical Sciences, Kings College, London, UK.,Upper Gastrointestinal Surgery, Guy's and St Thomas' NHS Trust, London, UK
| | - Andrew Davies
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.,School of Cancer and Pharmaceutical Sciences, Kings College, London, UK.,Upper Gastrointestinal Surgery, Guy's and St Thomas' NHS Trust, London, UK
| | - Jesper Lagergren
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.,School of Cancer and Pharmaceutical Sciences, Kings College, London, UK.,Upper Gastrointestinal Surgery, Guy's and St Thomas' NHS Trust, London, UK
| | - Pernilla Lagergren
- Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
| |
Collapse
|
20
|
Persson J, Fagevik Olsén M, Iresjö B, Smedh U. Body composition, sarcopenia, and quality of life in patients with oesophageal cancer before resection surgery and at follow‐up: a cohort study. JCSM CLINICAL REPORTS 2020. [DOI: 10.1002/crt2.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jan Persson
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg, Sahlgrenska University Hospital Gothenburg Sweden
| | - Monika Fagevik Olsén
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg, Sahlgrenska University Hospital Gothenburg Sweden
| | - Britt‐Marie Iresjö
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg, Sahlgrenska University Hospital Gothenburg Sweden
| | - Ulrika Smedh
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg, Sahlgrenska University Hospital Gothenburg Sweden
| |
Collapse
|
21
|
The value of GRASP on DCE-MRI for assessing response to neoadjuvant chemotherapy in patients with esophageal cancer. BMC Cancer 2019; 19:999. [PMID: 31651280 PMCID: PMC6814031 DOI: 10.1186/s12885-019-6247-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 10/03/2019] [Indexed: 12/12/2022] Open
Abstract
Background To compare the value of two dynamic contrast-enhanced Magnetic Resonance Images (DCE-MRI) reconstruction approaches, namely golden-angle radial sparse parallel (GRASP) and view-sharing with golden-angle radial profile (VS-GR) reconstruction, and evaluate their values in assessing response to neoadjuvant chemotherapy (nCT) in patients with esophageal cancer (EC). Methods EC patients receiving nCT before surgery were enrolled prospectively. DCE-MRI scanning was performed after nCT and within 1 week before surgery. Tumor Regression Grade (TRG) was used for chemotherapy response evaluation, and patients were stratified into a responsive group (TRG1 + 2) and a non-responsive group (TRG3 + 4 + 5). Wilcoxon test was utilized for comparing GRASP and VS-GR reconstruction, Kruskal-Wallis and Mann-Whitney test was performed for each parameter to assess response, and Spearman test was performed for analyzing correlation between parameters and TRGs, as well as responder and non-responder. The receiver operating characteristic (ROC) was utilized for each significant parameter to assess its accuracy between responders and non-responders. Results Among the 64 patients included in this cohort (52 male, 12 female; average age of 59.1 ± 7.9 years), 4 patients showed TRG1, 4 patients were TRG2, 7 patients were TRG3, 11 patients were TRG4, and 38 patients were TRG5. They were stratified into 8 responders and 56 non-responders. A total of 15 parameters were calculated from each tumor. With VS-GR, 10/15 parameters significantly correlated with TRG and response groups. Of these, only AUCmax showed moderate correlation with TRG, 7 showed low correlation and 2 showed negligible correlation with TRG. 8 showed low correlation and 2 showed negligible correlation with response groups. With GRASP, 13/15 parameters significantly correlated with TRG and response groups. Of these, 10 showed low correlation and 3 showed negligible correlation with TRG. 11 showed low correlation and 2 showed negligible correlation with TRG. Seven parameters (AUC* > 0.70, P < 0.05) showed good performance in response groups. Conclusions In patients with esophageal cancer on neoadjuvant chemotherapy, several parameters can differentiate responders from non-responders, using both GRASP and VS-GR techniques. GRASP may be able to better differentiate these two groups compared to VS-GR. Trial registration for this prospective study: ChiCTR, ChiCTR-DOD-14005308. Registered 2 October 2014.
Collapse
|
22
|
Noordman BJ, Verdam MGE, Onstenk B, Heisterkamp J, Jansen WJBM, Martijnse IS, Lagarde SM, Wijnhoven BPL, Acosta CMM, van der Gaast A, Sprangers MAG, van Lanschot JJB. Quality of Life During and After Completion of Neoadjuvant Chemoradiotherapy for Esophageal and Junctional Cancer. Ann Surg Oncol 2019; 26:4765-4772. [PMID: 31620943 PMCID: PMC6864114 DOI: 10.1245/s10434-019-07779-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Indexed: 12/28/2022]
Abstract
Background The course of health-related quality of life (HRQOL) during and after completion of neoadjuvant chemoradiotherapy (nCRT) for esophageal or junctional carcinoma is unknown. Methods This study was a multicenter prospective cohort investigation. Patients with esophageal or cancer to be treated with nCRT plus esophagectomy were eligible for inclusion in the study. The HRQOL of the patients was measured with European Organization for Research and Treatment of Cancer QLQ-C30, QLQ-OG25, and QLQ-CIPN20 questionnaires before and during nCRT, then 2, 4, 6, 8, 10, 12, 14, and 16 weeks after nCRT and before surgery. Predefined end points were based on the hypothesized impact of nCRT. The primary end points were physical functioning, odynophagia, and sensory symptoms. The secondary end points were global quality of life, fatigue, weight loss, and motor symptoms. Mixed modeling analysis was used to evaluate changes over time. Results Of 106 eligible patients, 96 (91%) were included in the study. The rate of questionnaires returned ranged from 94% to 99% until week 12, then dropped to 78% in week 16 after nCRT. A negative impact of nCRT on all HRQOL end points was observed during the last cycle of nCRT (all p < 0.001) and 2 weeks after nCRT (all p < 0.001). Physical functioning, odynophagia, and sensory symptoms were restored to pretreatment levels respectively 8, 4, and 6 weeks after nCRT. The secondary end points were restored to baseline levels 4–6 weeks after nCRT. Odynophagia, fatigue, and weight loss improved after nCRT compared with baseline levels at respectively 6 (p < 0.001), 16 (p = 0.001), and 12 weeks (p < 0.001). Conclusion After completion of nCRT for esophageal cancer, HRQOL decreases significantly, but all HRQOL end points are restored to baseline levels within 8 weeks. Odynophagia, fatigue, and weight loss improved 6–16 weeks after nCRT compared with baseline levels. Electronic supplementary material The online version of this article (10.1245/s10434-019-07779-w) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- B J Noordman
- Department of Surgery, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands.
| | - M G E Verdam
- Department of Medical Psychology, Academic Medical Centre, Amsterdam, The Netherlands
| | - B Onstenk
- Department of Surgery, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - J Heisterkamp
- Department of Surgery, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - W J B M Jansen
- Department of Surgery, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - I S Martijnse
- Department of Surgery, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - S M Lagarde
- Department of Surgery, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - B P L Wijnhoven
- Department of Surgery, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - C M M Acosta
- Department of Surgery, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - A van der Gaast
- Department of Medical Oncology, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - M A G Sprangers
- Department of Medical Psychology, Academic Medical Centre, Amsterdam, The Netherlands
| | - J J B van Lanschot
- Department of Surgery, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands
| |
Collapse
|
23
|
Sunde B, Klevebro F, Johar A, Johnsen G, Jacobsen AB, Glenjen NI, Friesland S, Lindblad M, Ajengui A, Lundell L, Lagergren P, Nilsson M. Health-related quality of life in a randomized trial of neoadjuvant chemotherapy or chemoradiotherapy plus surgery in patients with oesophageal cancer (NeoRes trial). Br J Surg 2019; 106:1452-1463. [PMID: 31436322 DOI: 10.1002/bjs.11246] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 04/02/2019] [Accepted: 05/02/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND There are few data comparing health-related quality of life (HRQoL) after neoadjuvant chemotherapy alone (nCT) compared with neoadjuvant chemoradiotherapy (nCRT) in patients with oesophageal cancer. METHODS In the NeoRes trial, patients were assigned randomly in a 1 : 1 ratio to receive either cisplatin 100 mg/m2 on day 1 and an infusion of 750 mg per m2 5-fluorouracil over 24 h on days 1-5 in three 21-day cycles (nCT) or the same chemotherapy regimen, but with the addition of 40 Gy radiotherapy (nCRT). HRQoL data were collected at baseline, after neoadjuvant therapy and at 1, 3 and 5 years after surgery. The European Organisation for Research and Treatment of Cancer (EORTC) core questionnaire QLQ-C30 and disease-specific modules were used. RESULTS Of 181 patients randomized, 165 were included in the analysis of HRQoL. In a direct comparison between the allocated treatments, odynophagia after completion of neoadjuvant therapy but before surgery (P = 0·047) and troublesome coughing at 3 years' follow-up (P = 0·011) were more pronounced in the nCRT arm. In the longitudinal analyses within each treatment arm, a large deterioration in HRQoL was noted at 1 year. Some recovery was seen in both arms over time but, after 3 and 5 years, patients in the nCRT arm reported more symptoms compared with baseline than patients in the nCT arm. CONCLUSION HRQoL after multimodal treatment for cancer of the oesophagus or gastro-oesophageal junction was impaired and more pronounced in patients who underwent nCRT, with only partial recovery over time.
Collapse
Affiliation(s)
- B Sunde
- Division of Surgery, Department of Clinical Science Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - F Klevebro
- Division of Surgery, Department of Clinical Science Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - A Johar
- Department of Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - G Johnsen
- Department of Gastrointestinal Surgery, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - A-B Jacobsen
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - N I Glenjen
- Department of Oncology, Haukeland University Hospital, Bergen, Norway
| | - S Friesland
- Department of Oncology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - M Lindblad
- Division of Surgery, Department of Clinical Science Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - A Ajengui
- Division of Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - L Lundell
- Division of Surgery, Department of Clinical Science Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - P Lagergren
- Department of 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
| | - M Nilsson
- Division of Surgery, Department of Clinical Science Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
24
|
O'Connell L, Coleman M, Kharyntiuk N, Walsh TN. Quality of life in patients with upper GI malignancies managed by a strategy of chemoradiotherapy alone versus surgery. Surg Oncol 2019; 30:33-39. [PMID: 31500782 DOI: 10.1016/j.suronc.2019.05.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 04/09/2019] [Accepted: 05/25/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND OBJECTIVES Neoadjuvant chemoradiotherapy (nCRT) induces a pathological complete response (pCR) in 25-85% of oesophago-gastric cancer. As surgery entails morbidity and mortality risks and quality of life (QL) impairment, its avoidance in patients without residual disease is desirable. This study aimed to compare quality of life of patients with a cCR who chose surveillance with those who chose surgery. METHODS Four groups of patients were studied. Group 1(n = 31) were controls; Group 2 (n = 26) had chemoradiotherapy only; Group 3 (n = 31) had oesophagectomy after nCRT; Group 4 (n = 26) had gastrectomy alone. A 33-point novel questionnaire was administered at two 3 month time points. Participants were also interviewed with a validated questionnaire. RESULTS Mean(±sd) quality of life scores in cCR patients offered surveillance (28.9 ± 4.5) were superior to patients undergoing oesophagectomy (32.3 ± 58. p=0.042) or gastrectomy (33.19 ± 5.9, p=0.004). This result was replicated in the validated questionnaire (p=0.017). There was a trend towards increased reflux-related respiratory symptoms in the oesophagectomy group (7.3 ± 2.2 vs 6.5 ± 1.9; p=0.396) and towards early dumping (8.2 ± 1.4 vs 7.1 ± 1.; p=0.239) and vagotomy-related symptoms (1.82 ± 0.9 vs 1.4 ± 0.6; p=0.438) in the gastrectomy group. CONCLUSIONS Avoidance of surgery in cCR patients is rewarded with a superior quality of life to those undergoing surgery.
Collapse
Affiliation(s)
- Lauren O'Connell
- Royal College of Surgeons in Ireland, Department of Surgery, Connolly Hospital, Blanchardstown, Dublin 15, Ireland.
| | - Mary Coleman
- Royal College of Surgeons in Ireland, Department of Surgery, Connolly Hospital, Blanchardstown, Dublin 15, Ireland
| | - N Kharyntiuk
- Royal College of Surgeons in Ireland, Department of Surgery, Connolly Hospital, Blanchardstown, Dublin 15, Ireland
| | - Thomas N Walsh
- Royal College of Surgeons in Ireland, Department of Surgery, Connolly Hospital, Blanchardstown, Dublin 15, Ireland; Royal College of Surgeons in Ireland, Department of Surgery, Beaumont Hospital, Dublin 9, Ireland
| |
Collapse
|
25
|
Bull J, Oster C, Flight I, Wilson C, Koczwara B, Watson DI, Bright T. The role of rehabilitation in patients undergoing oesophagectomy for cancer and pre-malignant disease: A qualitative exploration of the views of patients, carers and healthcare providers. Eur J Cancer Care (Engl) 2019; 28:e12996. [PMID: 30675740 DOI: 10.1111/ecc.12996] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 10/23/2018] [Accepted: 12/12/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Oesophagectomy for cancer is associated with significant morbidity and mortality, and reduced quality of life. Structured rehabilitation potentially offers improved physical and psychological outcomes. We aimed to explore patient, carer and healthcare provider attitudes and preferences towards the role of rehabilitation. METHODS We interviewed 15 patients who had undergone an oesophagectomy, 10 carers and 13 healthcare providers about perceived impacts of treatment; preferred components of a rehabilitation program; barriers/enablers of support provision; and participation in rehabilitation programs. Data were analysed using framework analysis. RESULTS The overarching theme was "Getting back to normal." Diagnosis of disease signified a disruption to the normal trajectory of patients' lives and the post-treatment period was characterised as striving to return to normal. Patients and carers focused on rehabilitation needs post-treatment including dietary support, physiotherapy and healthcare provider support. Healthcare providers described rehabilitation as potentially beneficial from the pre-treatment phase and, along with carers, highlighted the importance of psychological support. Barriers included access to services, cost of service provision and appointment burden. CONCLUSION A need for rehabilitation services was identified by healthcare providers from the point of diagnosis, rather than only after surgery. Implications include improved service provision by healthcare institutions for patients undergoing oesophagectomy.
Collapse
Affiliation(s)
- Jeff Bull
- College of Medicine and Public Health, Flinders University Discipline of Surgery, Bedford Park, South Australia, Australia
| | - Candice Oster
- Flinders Human Behaviour and Health Research Unit, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Ingrid Flight
- Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Carlene Wilson
- Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia.,La Trobe University/Olivia Newton John Cancer Wellness and Research Centre, Austin Hospital, Heidelberg, Victoria, Australia
| | - Bogda Koczwara
- Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - David I Watson
- College of Medicine and Public Health, Flinders University Discipline of Surgery, Bedford Park, South Australia, Australia
| | - Tim Bright
- College of Medicine and Public Health, Flinders University Discipline of Surgery, Bedford Park, South Australia, Australia
| |
Collapse
|
26
|
Zarean E, Mahmoudi M, Azimi T, Amini P. Determining Overall Survival and Risk Factors in Esophageal Cancer Using Censored Quantile Regression. Asian Pac J Cancer Prev 2018; 19:3081-3086. [PMID: 30485945 PMCID: PMC6318407 DOI: 10.31557/apjcp.2018.19.11.3081] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background: Esophageal cancer is one of the leading causes of death worldwide. The global increasing rate of this
type of cancer requires more attention. The purpose of this study was to determine the overall survival probability of
esophageal cancer after diagnosis and to assess the potential risk factors in a population of Iranian patients. Materials
and Methods: This retrospective cohort study was conducted on 127 cases with esophageal cancer in the Azarbaijan
province, East of Iran. Participants in the study were diagnosed during 2009-2010 and were followed up for 5 years. The
event was considered death due to esophageal cancer and those who survived until the end of the study were assumed as
right censored. Censored quntile regression was fitted to find the overall survival of the patients using adjusted effects of
variables and was compared with Cox regression model. Results: Patients’ mean and median survival time were 16.99
and 10.06 months respectively and 89% off cases died by the end of the study. The 1, 3, 6, 12 and 36-month survival
probabilities were 0.95, 0.76, 0.60, 0.43, and 0.18. The median survival time for females and males without surgery
were 21.79 and 14.76 month respectively. The accuracy of predictions were 0.99 and 0.74 for the censored quantile
regression and Cox, respectively. Conclusion: We concluded that being male, not having surgery, longer wait time
between having symptoms and being diagnosed, low socioeconomic status and old age to be significant risk factors in
reducing the probability of survival from esophageal cancer.
Collapse
Affiliation(s)
- Elaheh Zarean
- Modeling in Health Research Center, Department of Epidemiology and Biostatistics, School of Public Health, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | | | | | | |
Collapse
|
27
|
Olsen JR, Murphy JD, Huguet F, Hallemeier CL, Apisarnthanarax S, Jabbour SK. Gastrointestinal Cancers-Carving Out the Optimal Local Therapies in the Gastrointestinal Tract. Int J Radiat Oncol Biol Phys 2018; 102:233-242. [PMID: 30191854 PMCID: PMC11101013 DOI: 10.1016/j.ijrobp.2018.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 05/08/2018] [Indexed: 11/22/2022]
Affiliation(s)
- Jeffrey R Olsen
- Department of Radiation Oncology, University of Colorado, Denver, Colorado
| | - James D Murphy
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, California
| | - Florence Huguet
- Department of Radiation Oncology, Tenon Hospital, Paris Sorbonne University, Paris, France
| | | | - Smith Apisarnthanarax
- Department of Radiation Oncology, Seattle Cancer Care Alliance, University of Washington, Seattle, Washington
| | - Salma K Jabbour
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, New Jersey.
| |
Collapse
|
28
|
[Neoadjuvant chemoradiotherapy does not negatively impact the postoperative quality of life of esophageal cancer patients]. Strahlenther Onkol 2018; 194:794-796. [PMID: 29846752 DOI: 10.1007/s00066-018-1323-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
|
29
|
Zhang Y, Yang X, Geng D, Duan Y, Fu J. The change of health-related quality of life after minimally invasive esophagectomy for esophageal cancer: a meta-analysis. World J Surg Oncol 2018; 16:97. [PMID: 29793487 PMCID: PMC5968615 DOI: 10.1186/s12957-018-1330-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 02/04/2018] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Short- and long-term health-related quality of life (HRQL) was severely affected after surgery. This study aimed to assess the direction and duration of HRQL from 3- to 24-month follow-ups after minimally invasive esophagectomy (MIE) for esophageal cancer. METHODS A systematic literature search in MEDLINE, EMBASE, and the Cochrane database was performed for all potentially relevant studies published until February 2017. Studies were included if they addressed the question of HRQL with OERTC-QLQ-C30 and OES18. Primary outcomes were HRQL change at 3-month follow-up. Secondary outcomes were HRQL change from 3-, 6- (short-term) to 12- (mid-term), and/or 24-month (long-term) follow-ups. RESULTS Six articles were included to estimate the change in 24 HRQL outcomes after MIE. Most of the patients' HRQL outcomes deteriorated at short-term follow-up and some lasted to mid- or long-term after MIE. Patients' physical function and global QOL deteriorated from short- to long-term follow-ups, and emotional function had no change. The directions of dyspnea, pain, fatigue, insomnia, constipation, diarrhea, cough, and speech problems were increased. The deterioration in global function lasted 6 months, the increase in constipation and speech problems lasted 12 months, and insomnia increased more than 12 months after MIE. CONCLUSIONS The emotional function had no change after MIE. The global QOL become worse during early postoperative period; the symptoms of constipation, speech problems, and insomnia increased for a long time after MIE.
Collapse
Affiliation(s)
- Yong Zhang
- Department of Thoracic Surgery, the First Affiliated Hospital of Xi’an Jiaotong University, No. 277 West Yanta Road, Xi’an, 710061 China
| | - Xiaomei Yang
- Hospital 521 of China’s Ordnance Industry Group, Xi’an, 710065 China
| | - Donghong Geng
- School of Continuing Education of Xi’an Jiaotong University, Xi’an, 710061 China
| | - Yingfei Duan
- Department of Pathology, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, 710061 China
| | - Junke Fu
- Department of Thoracic Surgery, the First Affiliated Hospital of Xi’an Jiaotong University, No. 277 West Yanta Road, Xi’an, 710061 China
| |
Collapse
|
30
|
Harada K, Yoshida N, Baba Y, Nakamura K, Kosumi K, Ishimoto T, Iwatsuki M, Miyamoto Y, Sakamoto Y, Ajani JA, Watanabe M, Baba H. Pyloroplasty may reduce weight loss 1 year after esophagectomy. Dis Esophagus 2018; 31:4944973. [PMID: 29579257 DOI: 10.1093/dote/dox127] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 09/19/2017] [Indexed: 12/11/2022]
Abstract
Weight loss after esophagectomy is common and is associated with unfavorable prognosis. However, the clinical features and surgical methods that influence postesophagectomy weight loss are not well characterized. This study aims to determine those features (especially the surgical methods) that may affect postoperative weight loss. We reviewed 221 esophageal cancer patients who had undergone esophagectomy at Kumamoto University Hospital (Kumamoto, Japan) between November 2012 and June 2015. Among these, we recruited 106 patients who had undergone transthoracic esophagectomy with gastric conduit reconstruction, had no cancer recurrence within 1 year, and no missing follow-up data. We tabulated the body weight changes and risk factors associated with weight loss exceeding 10% at 1-year postesophagectomy. The mean body weights at baseline and 1-year postsurgery were 60.3 kg (standard error (SE): 0.91) and 52.6 (SE: 0.91), respectively. One year postsurgery, the body weights had changed as follows: mean: -12.2%; median: -12.9%; standard deviation: 9.06; range: -36.1-18.56%; interquartile range: -10.5 to -14.0%. In the multivariate logistic regression analysis, the absence of pyloroplasty was the sole risk factor for more than 10% weight loss (OR: 3.22; 95% CI: 1.08-11.9; P = 0.036). Our data suggest that pyloroplasty with esophagectomy can overcome the post-surgical weight loss.
Collapse
Affiliation(s)
- K Harada
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto.,Department of Gastrointestinal Medical Oncology at the University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - N Yoshida
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto
| | - Y Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto
| | - K Nakamura
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto
| | - K Kosumi
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto
| | - T Ishimoto
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto
| | - M Iwatsuki
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto
| | - Y Miyamoto
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto
| | - Y Sakamoto
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto
| | - J A Ajani
- Department of Gastrointestinal Medical Oncology at the University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - M Watanabe
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Koto-ku, Tokyo, Japan
| | - H Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto
| |
Collapse
|
31
|
Kauppila JH, Johar A, Gossage JA, Davies AR, Zylstra J, Lagergren J, Lagergren P. Health-related quality of life after open transhiatal and transthoracic oesophagectomy for cancer. Br J Surg 2018; 105:230-236. [DOI: 10.1002/bjs.10745] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 09/11/2017] [Accepted: 10/02/2017] [Indexed: 01/07/2023]
Abstract
Abstract
Background
Transhiatal and transthoracic oesophagectomy in patients with oesophageal cancer have similar survival rates. Whether these approaches differ in health-related quality of life (HRQoL) is uncertain and was examined in this study.
Methods
Patients undergoing transhiatal or transthoracic surgery for lower-third oesophageal or gastro-oesophageal junctional cancer between 2011 and 2015 were selected from an institutional database. HRQoL outcomes were measured at 6 and 12 months after surgery using validated written questionnaires (European Organisation for Research and Treatment of Cancer QLQ-C30 and QLQ-OG25). Linear mixed models provided mean score differences (MSDs) with 95 per cent confidence intervals, adjusted for preoperative HRQoL, age, physical status (ASA fitness grade), tumour location, tumour stage, neoadjuvant therapy, adjuvant therapy and postoperative complications. MSD values of 10 or more were regarded as clinically relevant.
Results
Some 146 patients underwent transhiatal (86, 58·9 per cent) or transthoracic (60, 41·1 per cent) oesophagectomy. The HRQoL questionnaires were returned by 111 patients at 6 months and 74 at 12 months. At 6 months, transthoracic oesophagectomy was associated with worse role function (MSD –12, 95 per cent c.i. –23 to 0; P = 0·046). At 12 months, patients in the transthoracic group had more nausea and vomiting (MSD 11, 0 to 22; P = 0·045), dyspnoea (MSD 13, 1 to 25; P = 0·029) and constipation (MSD 20, 7 to 33; P = 0·003) than those in the transhiatal group.
Conclusion
Transhiatal oesophagectomy seems to offer better HRQoL than transthoracic oesophagectomy 6 and 12 months after surgery.
Collapse
Affiliation(s)
- J H Kauppila
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
- Cancer and Translational Medicine Research Unit, Medical Research Centre, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - A Johar
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - J A Gossage
- Division of Cancer Studies, King's College London, London, UK
- Department of Surgery, Guy's and St Thomas' Oesophago-Gastric Centre, London, UK
| | - A R Davies
- Division of Cancer Studies, King's College London, London, UK
- Department of Surgery, Guy's and St Thomas' Oesophago-Gastric Centre, London, UK
| | - J Zylstra
- Division of Cancer Studies, King's College London, London, UK
- Department of Surgery, Guy's and St Thomas' Oesophago-Gastric Centre, London, UK
| | - J Lagergren
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
- Division of Cancer Studies, King's College London, London, UK
- Department of Surgery, Guy's and St Thomas' Oesophago-Gastric Centre, London, UK
| | - P Lagergren
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
32
|
Noordman B, Verdam M, Lagarde S, Shapiro J, Hulshof M, van Berge Henegouwen M, Wijnhoven B, Nieuwenhuijzen G, Bonenkamp J, Cuesta M, Plukker J, Spillenaar Bilgen E, Steyerberg E, van der Gaast A, Sprangers M, van Lanschot J. Impact of neoadjuvant chemoradiotherapy on health-related quality of life in long-term survivors of esophageal or junctional cancer: results from the randomized CROSS trial. Ann Oncol 2018; 29:445-451. [DOI: 10.1093/annonc/mdx726] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
|
33
|
Noordman BJ, Verdam MG, Lagarde SM, Hulshof MC, van Hagen P, van Berge Henegouwen MI, Wijnhoven BP, van Laarhoven HW, Nieuwenhuijzen GA, Hospers GA, Bonenkamp JJ, Cuesta MA, Blaisse RJ, Busch OR, ten Kate FJ, Creemers GJM, Punt CJ, Plukker JT, Verheul HM, Spillenaar Bilgen EJ, van Dekken H, van der Sangen MJ, Rozema T, Biermann K, Beukema JC, Piet AH, van Rij CM, Reinders JG, Tilanus HW, Steyerberg EW, van der Gaast A, Sprangers MA, van Lanschot JJB. Effect of Neoadjuvant Chemoradiotherapy on Health-Related Quality of Life in Esophageal or Junctional Cancer: Results From the Randomized CROSS Trial. J Clin Oncol 2018; 36:268-275. [DOI: 10.1200/jco.2017.73.7718] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Purpose To compare pre-agreed health-related quality of life (HRQOL) domains in patients with esophageal or junctional cancer who received neoadjuvant chemoradiotherapy (nCRT) followed by surgery or surgery alone. Secondary aims were to examine the effect of nCRT on HRQOL before surgery and the effect of surgery on HRQOL. Patients and Methods Patients were randomly assigned to nCRT (carboplatin plus paclitaxel with concurrent 41.4-Gy radiotherapy) followed by surgery or surgery alone. HRQOL was measured using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire–Core 30 (QLQ-C30) and –Oesophageal Cancer Module (QLQ-OES24) questionnaires pretreatment and at 3, 6, 9, and 12 months postoperatively. The nCRT group also received preoperative questionnaires. Physical functioning (PF; QLQ-C30) and eating problems (EA; QLQ-OES24) were chosen as predefined primary end points. Predefined secondary end points were global QOL (GQOL; QLQ-C30), fatigue (FA; QLQ-C30), and emotional problems (EM; QLQ-OES24). Results A total of 363 patients were analyzed. No statistically significant differences in postoperative HRQOL were found between treatment groups. In the nCRT group, PF, EA, GQOL, FA, and EM scores deteriorated 1 week after nCRT (Cohen’s d: −0.93, P < .001; 0.47, P < .001; −0.84, P < .001; 1.45, P < .001; and 0.32, P = .001, respectively). In both treatment groups, all end points declined 3 months postoperatively compared with baseline (Cohen’s d: −1.00, 0.33, −0.47, −0.34, and 0.33, respectively; all P < .001), followed by a continuous gradual improvement. EA, GQOL, and EM were restored to baseline levels during follow-up, whereas PF and FA remained impaired 1 year postoperatively (Cohen’s d: 0.52 and −0.53, respectively; both P < .001). Conclusion Although HRQOL declined during nCRT, no effect of nCRT was apparent on postoperative HRQOL compared with surgery alone. In addition to the improvement in survival, these findings support the view that nCRT according to the Chemoradiotherapy for Esophageal Cancer Followed by Surgery Study–regimen can be regarded as a standard of care.
Collapse
Affiliation(s)
- Bo Jan Noordman
- Bo Jan Noordman, Sjoerd M. Lagarde, Pieter van Hagen, Bas P.L. Wijnhoven, Fiebo J.W. ten Kate, Katharina Biermann, Caroline M. van Rij, Hugo W. Tilanus, Ewout W. Steyerberg, Ate van der Gaast, and J. Jan B. van Lanschot, Erasmus MC–University Medical Center Rotterdam; Mathilde G.E. Verdam, Maarten C.C.M. Hulshof, Mark I. van Berge Henegouwen, Hanneke W.M. van Laarhoven, Olivier R. Busch, Fiebo J.W. ten Kate, Cornelis J.A. Punt, and Mirjam A.G. Sprangers, Academic Medical Center; Miguel A. Cuesta, Henk M
| | - Mathilde G.E. Verdam
- Bo Jan Noordman, Sjoerd M. Lagarde, Pieter van Hagen, Bas P.L. Wijnhoven, Fiebo J.W. ten Kate, Katharina Biermann, Caroline M. van Rij, Hugo W. Tilanus, Ewout W. Steyerberg, Ate van der Gaast, and J. Jan B. van Lanschot, Erasmus MC–University Medical Center Rotterdam; Mathilde G.E. Verdam, Maarten C.C.M. Hulshof, Mark I. van Berge Henegouwen, Hanneke W.M. van Laarhoven, Olivier R. Busch, Fiebo J.W. ten Kate, Cornelis J.A. Punt, and Mirjam A.G. Sprangers, Academic Medical Center; Miguel A. Cuesta, Henk M
| | - Sjoerd M. Lagarde
- Bo Jan Noordman, Sjoerd M. Lagarde, Pieter van Hagen, Bas P.L. Wijnhoven, Fiebo J.W. ten Kate, Katharina Biermann, Caroline M. van Rij, Hugo W. Tilanus, Ewout W. Steyerberg, Ate van der Gaast, and J. Jan B. van Lanschot, Erasmus MC–University Medical Center Rotterdam; Mathilde G.E. Verdam, Maarten C.C.M. Hulshof, Mark I. van Berge Henegouwen, Hanneke W.M. van Laarhoven, Olivier R. Busch, Fiebo J.W. ten Kate, Cornelis J.A. Punt, and Mirjam A.G. Sprangers, Academic Medical Center; Miguel A. Cuesta, Henk M
| | - Maarten C.C.M. Hulshof
- Bo Jan Noordman, Sjoerd M. Lagarde, Pieter van Hagen, Bas P.L. Wijnhoven, Fiebo J.W. ten Kate, Katharina Biermann, Caroline M. van Rij, Hugo W. Tilanus, Ewout W. Steyerberg, Ate van der Gaast, and J. Jan B. van Lanschot, Erasmus MC–University Medical Center Rotterdam; Mathilde G.E. Verdam, Maarten C.C.M. Hulshof, Mark I. van Berge Henegouwen, Hanneke W.M. van Laarhoven, Olivier R. Busch, Fiebo J.W. ten Kate, Cornelis J.A. Punt, and Mirjam A.G. Sprangers, Academic Medical Center; Miguel A. Cuesta, Henk M
| | - Pieter van Hagen
- Bo Jan Noordman, Sjoerd M. Lagarde, Pieter van Hagen, Bas P.L. Wijnhoven, Fiebo J.W. ten Kate, Katharina Biermann, Caroline M. van Rij, Hugo W. Tilanus, Ewout W. Steyerberg, Ate van der Gaast, and J. Jan B. van Lanschot, Erasmus MC–University Medical Center Rotterdam; Mathilde G.E. Verdam, Maarten C.C.M. Hulshof, Mark I. van Berge Henegouwen, Hanneke W.M. van Laarhoven, Olivier R. Busch, Fiebo J.W. ten Kate, Cornelis J.A. Punt, and Mirjam A.G. Sprangers, Academic Medical Center; Miguel A. Cuesta, Henk M
| | - Mark I. van Berge Henegouwen
- Bo Jan Noordman, Sjoerd M. Lagarde, Pieter van Hagen, Bas P.L. Wijnhoven, Fiebo J.W. ten Kate, Katharina Biermann, Caroline M. van Rij, Hugo W. Tilanus, Ewout W. Steyerberg, Ate van der Gaast, and J. Jan B. van Lanschot, Erasmus MC–University Medical Center Rotterdam; Mathilde G.E. Verdam, Maarten C.C.M. Hulshof, Mark I. van Berge Henegouwen, Hanneke W.M. van Laarhoven, Olivier R. Busch, Fiebo J.W. ten Kate, Cornelis J.A. Punt, and Mirjam A.G. Sprangers, Academic Medical Center; Miguel A. Cuesta, Henk M
| | - Bas P.L. Wijnhoven
- Bo Jan Noordman, Sjoerd M. Lagarde, Pieter van Hagen, Bas P.L. Wijnhoven, Fiebo J.W. ten Kate, Katharina Biermann, Caroline M. van Rij, Hugo W. Tilanus, Ewout W. Steyerberg, Ate van der Gaast, and J. Jan B. van Lanschot, Erasmus MC–University Medical Center Rotterdam; Mathilde G.E. Verdam, Maarten C.C.M. Hulshof, Mark I. van Berge Henegouwen, Hanneke W.M. van Laarhoven, Olivier R. Busch, Fiebo J.W. ten Kate, Cornelis J.A. Punt, and Mirjam A.G. Sprangers, Academic Medical Center; Miguel A. Cuesta, Henk M
| | - Hanneke W.M. van Laarhoven
- Bo Jan Noordman, Sjoerd M. Lagarde, Pieter van Hagen, Bas P.L. Wijnhoven, Fiebo J.W. ten Kate, Katharina Biermann, Caroline M. van Rij, Hugo W. Tilanus, Ewout W. Steyerberg, Ate van der Gaast, and J. Jan B. van Lanschot, Erasmus MC–University Medical Center Rotterdam; Mathilde G.E. Verdam, Maarten C.C.M. Hulshof, Mark I. van Berge Henegouwen, Hanneke W.M. van Laarhoven, Olivier R. Busch, Fiebo J.W. ten Kate, Cornelis J.A. Punt, and Mirjam A.G. Sprangers, Academic Medical Center; Miguel A. Cuesta, Henk M
| | - Grard A.P. Nieuwenhuijzen
- Bo Jan Noordman, Sjoerd M. Lagarde, Pieter van Hagen, Bas P.L. Wijnhoven, Fiebo J.W. ten Kate, Katharina Biermann, Caroline M. van Rij, Hugo W. Tilanus, Ewout W. Steyerberg, Ate van der Gaast, and J. Jan B. van Lanschot, Erasmus MC–University Medical Center Rotterdam; Mathilde G.E. Verdam, Maarten C.C.M. Hulshof, Mark I. van Berge Henegouwen, Hanneke W.M. van Laarhoven, Olivier R. Busch, Fiebo J.W. ten Kate, Cornelis J.A. Punt, and Mirjam A.G. Sprangers, Academic Medical Center; Miguel A. Cuesta, Henk M
| | - Geke A.P. Hospers
- Bo Jan Noordman, Sjoerd M. Lagarde, Pieter van Hagen, Bas P.L. Wijnhoven, Fiebo J.W. ten Kate, Katharina Biermann, Caroline M. van Rij, Hugo W. Tilanus, Ewout W. Steyerberg, Ate van der Gaast, and J. Jan B. van Lanschot, Erasmus MC–University Medical Center Rotterdam; Mathilde G.E. Verdam, Maarten C.C.M. Hulshof, Mark I. van Berge Henegouwen, Hanneke W.M. van Laarhoven, Olivier R. Busch, Fiebo J.W. ten Kate, Cornelis J.A. Punt, and Mirjam A.G. Sprangers, Academic Medical Center; Miguel A. Cuesta, Henk M
| | - Johannes J. Bonenkamp
- Bo Jan Noordman, Sjoerd M. Lagarde, Pieter van Hagen, Bas P.L. Wijnhoven, Fiebo J.W. ten Kate, Katharina Biermann, Caroline M. van Rij, Hugo W. Tilanus, Ewout W. Steyerberg, Ate van der Gaast, and J. Jan B. van Lanschot, Erasmus MC–University Medical Center Rotterdam; Mathilde G.E. Verdam, Maarten C.C.M. Hulshof, Mark I. van Berge Henegouwen, Hanneke W.M. van Laarhoven, Olivier R. Busch, Fiebo J.W. ten Kate, Cornelis J.A. Punt, and Mirjam A.G. Sprangers, Academic Medical Center; Miguel A. Cuesta, Henk M
| | - Miguel A. Cuesta
- Bo Jan Noordman, Sjoerd M. Lagarde, Pieter van Hagen, Bas P.L. Wijnhoven, Fiebo J.W. ten Kate, Katharina Biermann, Caroline M. van Rij, Hugo W. Tilanus, Ewout W. Steyerberg, Ate van der Gaast, and J. Jan B. van Lanschot, Erasmus MC–University Medical Center Rotterdam; Mathilde G.E. Verdam, Maarten C.C.M. Hulshof, Mark I. van Berge Henegouwen, Hanneke W.M. van Laarhoven, Olivier R. Busch, Fiebo J.W. ten Kate, Cornelis J.A. Punt, and Mirjam A.G. Sprangers, Academic Medical Center; Miguel A. Cuesta, Henk M
| | - Reinoud J.B. Blaisse
- Bo Jan Noordman, Sjoerd M. Lagarde, Pieter van Hagen, Bas P.L. Wijnhoven, Fiebo J.W. ten Kate, Katharina Biermann, Caroline M. van Rij, Hugo W. Tilanus, Ewout W. Steyerberg, Ate van der Gaast, and J. Jan B. van Lanschot, Erasmus MC–University Medical Center Rotterdam; Mathilde G.E. Verdam, Maarten C.C.M. Hulshof, Mark I. van Berge Henegouwen, Hanneke W.M. van Laarhoven, Olivier R. Busch, Fiebo J.W. ten Kate, Cornelis J.A. Punt, and Mirjam A.G. Sprangers, Academic Medical Center; Miguel A. Cuesta, Henk M
| | - Olivier R. Busch
- Bo Jan Noordman, Sjoerd M. Lagarde, Pieter van Hagen, Bas P.L. Wijnhoven, Fiebo J.W. ten Kate, Katharina Biermann, Caroline M. van Rij, Hugo W. Tilanus, Ewout W. Steyerberg, Ate van der Gaast, and J. Jan B. van Lanschot, Erasmus MC–University Medical Center Rotterdam; Mathilde G.E. Verdam, Maarten C.C.M. Hulshof, Mark I. van Berge Henegouwen, Hanneke W.M. van Laarhoven, Olivier R. Busch, Fiebo J.W. ten Kate, Cornelis J.A. Punt, and Mirjam A.G. Sprangers, Academic Medical Center; Miguel A. Cuesta, Henk M
| | - Fiebo J.W. ten Kate
- Bo Jan Noordman, Sjoerd M. Lagarde, Pieter van Hagen, Bas P.L. Wijnhoven, Fiebo J.W. ten Kate, Katharina Biermann, Caroline M. van Rij, Hugo W. Tilanus, Ewout W. Steyerberg, Ate van der Gaast, and J. Jan B. van Lanschot, Erasmus MC–University Medical Center Rotterdam; Mathilde G.E. Verdam, Maarten C.C.M. Hulshof, Mark I. van Berge Henegouwen, Hanneke W.M. van Laarhoven, Olivier R. Busch, Fiebo J.W. ten Kate, Cornelis J.A. Punt, and Mirjam A.G. Sprangers, Academic Medical Center; Miguel A. Cuesta, Henk M
| | - Geert-Jan M. Creemers
- Bo Jan Noordman, Sjoerd M. Lagarde, Pieter van Hagen, Bas P.L. Wijnhoven, Fiebo J.W. ten Kate, Katharina Biermann, Caroline M. van Rij, Hugo W. Tilanus, Ewout W. Steyerberg, Ate van der Gaast, and J. Jan B. van Lanschot, Erasmus MC–University Medical Center Rotterdam; Mathilde G.E. Verdam, Maarten C.C.M. Hulshof, Mark I. van Berge Henegouwen, Hanneke W.M. van Laarhoven, Olivier R. Busch, Fiebo J.W. ten Kate, Cornelis J.A. Punt, and Mirjam A.G. Sprangers, Academic Medical Center; Miguel A. Cuesta, Henk M
| | - Cornelis J.A. Punt
- Bo Jan Noordman, Sjoerd M. Lagarde, Pieter van Hagen, Bas P.L. Wijnhoven, Fiebo J.W. ten Kate, Katharina Biermann, Caroline M. van Rij, Hugo W. Tilanus, Ewout W. Steyerberg, Ate van der Gaast, and J. Jan B. van Lanschot, Erasmus MC–University Medical Center Rotterdam; Mathilde G.E. Verdam, Maarten C.C.M. Hulshof, Mark I. van Berge Henegouwen, Hanneke W.M. van Laarhoven, Olivier R. Busch, Fiebo J.W. ten Kate, Cornelis J.A. Punt, and Mirjam A.G. Sprangers, Academic Medical Center; Miguel A. Cuesta, Henk M
| | - John Th.M. Plukker
- Bo Jan Noordman, Sjoerd M. Lagarde, Pieter van Hagen, Bas P.L. Wijnhoven, Fiebo J.W. ten Kate, Katharina Biermann, Caroline M. van Rij, Hugo W. Tilanus, Ewout W. Steyerberg, Ate van der Gaast, and J. Jan B. van Lanschot, Erasmus MC–University Medical Center Rotterdam; Mathilde G.E. Verdam, Maarten C.C.M. Hulshof, Mark I. van Berge Henegouwen, Hanneke W.M. van Laarhoven, Olivier R. Busch, Fiebo J.W. ten Kate, Cornelis J.A. Punt, and Mirjam A.G. Sprangers, Academic Medical Center; Miguel A. Cuesta, Henk M
| | - Henk M.W. Verheul
- Bo Jan Noordman, Sjoerd M. Lagarde, Pieter van Hagen, Bas P.L. Wijnhoven, Fiebo J.W. ten Kate, Katharina Biermann, Caroline M. van Rij, Hugo W. Tilanus, Ewout W. Steyerberg, Ate van der Gaast, and J. Jan B. van Lanschot, Erasmus MC–University Medical Center Rotterdam; Mathilde G.E. Verdam, Maarten C.C.M. Hulshof, Mark I. van Berge Henegouwen, Hanneke W.M. van Laarhoven, Olivier R. Busch, Fiebo J.W. ten Kate, Cornelis J.A. Punt, and Mirjam A.G. Sprangers, Academic Medical Center; Miguel A. Cuesta, Henk M
| | - Ernst J. Spillenaar Bilgen
- Bo Jan Noordman, Sjoerd M. Lagarde, Pieter van Hagen, Bas P.L. Wijnhoven, Fiebo J.W. ten Kate, Katharina Biermann, Caroline M. van Rij, Hugo W. Tilanus, Ewout W. Steyerberg, Ate van der Gaast, and J. Jan B. van Lanschot, Erasmus MC–University Medical Center Rotterdam; Mathilde G.E. Verdam, Maarten C.C.M. Hulshof, Mark I. van Berge Henegouwen, Hanneke W.M. van Laarhoven, Olivier R. Busch, Fiebo J.W. ten Kate, Cornelis J.A. Punt, and Mirjam A.G. Sprangers, Academic Medical Center; Miguel A. Cuesta, Henk M
| | - Herman van Dekken
- Bo Jan Noordman, Sjoerd M. Lagarde, Pieter van Hagen, Bas P.L. Wijnhoven, Fiebo J.W. ten Kate, Katharina Biermann, Caroline M. van Rij, Hugo W. Tilanus, Ewout W. Steyerberg, Ate van der Gaast, and J. Jan B. van Lanschot, Erasmus MC–University Medical Center Rotterdam; Mathilde G.E. Verdam, Maarten C.C.M. Hulshof, Mark I. van Berge Henegouwen, Hanneke W.M. van Laarhoven, Olivier R. Busch, Fiebo J.W. ten Kate, Cornelis J.A. Punt, and Mirjam A.G. Sprangers, Academic Medical Center; Miguel A. Cuesta, Henk M
| | - Maurice J.C. van der Sangen
- Bo Jan Noordman, Sjoerd M. Lagarde, Pieter van Hagen, Bas P.L. Wijnhoven, Fiebo J.W. ten Kate, Katharina Biermann, Caroline M. van Rij, Hugo W. Tilanus, Ewout W. Steyerberg, Ate van der Gaast, and J. Jan B. van Lanschot, Erasmus MC–University Medical Center Rotterdam; Mathilde G.E. Verdam, Maarten C.C.M. Hulshof, Mark I. van Berge Henegouwen, Hanneke W.M. van Laarhoven, Olivier R. Busch, Fiebo J.W. ten Kate, Cornelis J.A. Punt, and Mirjam A.G. Sprangers, Academic Medical Center; Miguel A. Cuesta, Henk M
| | - Tom Rozema
- Bo Jan Noordman, Sjoerd M. Lagarde, Pieter van Hagen, Bas P.L. Wijnhoven, Fiebo J.W. ten Kate, Katharina Biermann, Caroline M. van Rij, Hugo W. Tilanus, Ewout W. Steyerberg, Ate van der Gaast, and J. Jan B. van Lanschot, Erasmus MC–University Medical Center Rotterdam; Mathilde G.E. Verdam, Maarten C.C.M. Hulshof, Mark I. van Berge Henegouwen, Hanneke W.M. van Laarhoven, Olivier R. Busch, Fiebo J.W. ten Kate, Cornelis J.A. Punt, and Mirjam A.G. Sprangers, Academic Medical Center; Miguel A. Cuesta, Henk M
| | - Katharina Biermann
- Bo Jan Noordman, Sjoerd M. Lagarde, Pieter van Hagen, Bas P.L. Wijnhoven, Fiebo J.W. ten Kate, Katharina Biermann, Caroline M. van Rij, Hugo W. Tilanus, Ewout W. Steyerberg, Ate van der Gaast, and J. Jan B. van Lanschot, Erasmus MC–University Medical Center Rotterdam; Mathilde G.E. Verdam, Maarten C.C.M. Hulshof, Mark I. van Berge Henegouwen, Hanneke W.M. van Laarhoven, Olivier R. Busch, Fiebo J.W. ten Kate, Cornelis J.A. Punt, and Mirjam A.G. Sprangers, Academic Medical Center; Miguel A. Cuesta, Henk M
| | - Jannet C. Beukema
- Bo Jan Noordman, Sjoerd M. Lagarde, Pieter van Hagen, Bas P.L. Wijnhoven, Fiebo J.W. ten Kate, Katharina Biermann, Caroline M. van Rij, Hugo W. Tilanus, Ewout W. Steyerberg, Ate van der Gaast, and J. Jan B. van Lanschot, Erasmus MC–University Medical Center Rotterdam; Mathilde G.E. Verdam, Maarten C.C.M. Hulshof, Mark I. van Berge Henegouwen, Hanneke W.M. van Laarhoven, Olivier R. Busch, Fiebo J.W. ten Kate, Cornelis J.A. Punt, and Mirjam A.G. Sprangers, Academic Medical Center; Miguel A. Cuesta, Henk M
| | - Anna H.M. Piet
- Bo Jan Noordman, Sjoerd M. Lagarde, Pieter van Hagen, Bas P.L. Wijnhoven, Fiebo J.W. ten Kate, Katharina Biermann, Caroline M. van Rij, Hugo W. Tilanus, Ewout W. Steyerberg, Ate van der Gaast, and J. Jan B. van Lanschot, Erasmus MC–University Medical Center Rotterdam; Mathilde G.E. Verdam, Maarten C.C.M. Hulshof, Mark I. van Berge Henegouwen, Hanneke W.M. van Laarhoven, Olivier R. Busch, Fiebo J.W. ten Kate, Cornelis J.A. Punt, and Mirjam A.G. Sprangers, Academic Medical Center; Miguel A. Cuesta, Henk M
| | - Caroline M. van Rij
- Bo Jan Noordman, Sjoerd M. Lagarde, Pieter van Hagen, Bas P.L. Wijnhoven, Fiebo J.W. ten Kate, Katharina Biermann, Caroline M. van Rij, Hugo W. Tilanus, Ewout W. Steyerberg, Ate van der Gaast, and J. Jan B. van Lanschot, Erasmus MC–University Medical Center Rotterdam; Mathilde G.E. Verdam, Maarten C.C.M. Hulshof, Mark I. van Berge Henegouwen, Hanneke W.M. van Laarhoven, Olivier R. Busch, Fiebo J.W. ten Kate, Cornelis J.A. Punt, and Mirjam A.G. Sprangers, Academic Medical Center; Miguel A. Cuesta, Henk M
| | - Janny G. Reinders
- Bo Jan Noordman, Sjoerd M. Lagarde, Pieter van Hagen, Bas P.L. Wijnhoven, Fiebo J.W. ten Kate, Katharina Biermann, Caroline M. van Rij, Hugo W. Tilanus, Ewout W. Steyerberg, Ate van der Gaast, and J. Jan B. van Lanschot, Erasmus MC–University Medical Center Rotterdam; Mathilde G.E. Verdam, Maarten C.C.M. Hulshof, Mark I. van Berge Henegouwen, Hanneke W.M. van Laarhoven, Olivier R. Busch, Fiebo J.W. ten Kate, Cornelis J.A. Punt, and Mirjam A.G. Sprangers, Academic Medical Center; Miguel A. Cuesta, Henk M
| | - Hugo W. Tilanus
- Bo Jan Noordman, Sjoerd M. Lagarde, Pieter van Hagen, Bas P.L. Wijnhoven, Fiebo J.W. ten Kate, Katharina Biermann, Caroline M. van Rij, Hugo W. Tilanus, Ewout W. Steyerberg, Ate van der Gaast, and J. Jan B. van Lanschot, Erasmus MC–University Medical Center Rotterdam; Mathilde G.E. Verdam, Maarten C.C.M. Hulshof, Mark I. van Berge Henegouwen, Hanneke W.M. van Laarhoven, Olivier R. Busch, Fiebo J.W. ten Kate, Cornelis J.A. Punt, and Mirjam A.G. Sprangers, Academic Medical Center; Miguel A. Cuesta, Henk M
| | - Ewout W. Steyerberg
- Bo Jan Noordman, Sjoerd M. Lagarde, Pieter van Hagen, Bas P.L. Wijnhoven, Fiebo J.W. ten Kate, Katharina Biermann, Caroline M. van Rij, Hugo W. Tilanus, Ewout W. Steyerberg, Ate van der Gaast, and J. Jan B. van Lanschot, Erasmus MC–University Medical Center Rotterdam; Mathilde G.E. Verdam, Maarten C.C.M. Hulshof, Mark I. van Berge Henegouwen, Hanneke W.M. van Laarhoven, Olivier R. Busch, Fiebo J.W. ten Kate, Cornelis J.A. Punt, and Mirjam A.G. Sprangers, Academic Medical Center; Miguel A. Cuesta, Henk M
| | - Ate van der Gaast
- Bo Jan Noordman, Sjoerd M. Lagarde, Pieter van Hagen, Bas P.L. Wijnhoven, Fiebo J.W. ten Kate, Katharina Biermann, Caroline M. van Rij, Hugo W. Tilanus, Ewout W. Steyerberg, Ate van der Gaast, and J. Jan B. van Lanschot, Erasmus MC–University Medical Center Rotterdam; Mathilde G.E. Verdam, Maarten C.C.M. Hulshof, Mark I. van Berge Henegouwen, Hanneke W.M. van Laarhoven, Olivier R. Busch, Fiebo J.W. ten Kate, Cornelis J.A. Punt, and Mirjam A.G. Sprangers, Academic Medical Center; Miguel A. Cuesta, Henk M
| | - Mirjam A.G. Sprangers
- Bo Jan Noordman, Sjoerd M. Lagarde, Pieter van Hagen, Bas P.L. Wijnhoven, Fiebo J.W. ten Kate, Katharina Biermann, Caroline M. van Rij, Hugo W. Tilanus, Ewout W. Steyerberg, Ate van der Gaast, and J. Jan B. van Lanschot, Erasmus MC–University Medical Center Rotterdam; Mathilde G.E. Verdam, Maarten C.C.M. Hulshof, Mark I. van Berge Henegouwen, Hanneke W.M. van Laarhoven, Olivier R. Busch, Fiebo J.W. ten Kate, Cornelis J.A. Punt, and Mirjam A.G. Sprangers, Academic Medical Center; Miguel A. Cuesta, Henk M
| | - J. Jan B. van Lanschot
- Bo Jan Noordman, Sjoerd M. Lagarde, Pieter van Hagen, Bas P.L. Wijnhoven, Fiebo J.W. ten Kate, Katharina Biermann, Caroline M. van Rij, Hugo W. Tilanus, Ewout W. Steyerberg, Ate van der Gaast, and J. Jan B. van Lanschot, Erasmus MC–University Medical Center Rotterdam; Mathilde G.E. Verdam, Maarten C.C.M. Hulshof, Mark I. van Berge Henegouwen, Hanneke W.M. van Laarhoven, Olivier R. Busch, Fiebo J.W. ten Kate, Cornelis J.A. Punt, and Mirjam A.G. Sprangers, Academic Medical Center; Miguel A. Cuesta, Henk M
| |
Collapse
|
34
|
Abstract
Oesophageal cancer is a clinically challenging disease that requires a multidisciplinary approach. Extensive treatment might be associated with a considerable decline in health-related quality of life and yet still a poor prognosis. In recent decades, prognosis has gradually improved in many countries. Endoscopic procedures have increasingly been used in the treatment of premalignant and early oesophageal tumours. Neoadjuvant therapy with chemotherapy or chemoradiotherapy has supplemented surgery as standard treatment of locally advanced oesophageal cancer. Surgery has become more standardised and centralised. Several therapeutic alternatives are available for palliative treatment. This Seminar aims to provide insights into the current clinical management, ongoing controversies, and future needs in oesophageal cancer.
Collapse
Affiliation(s)
- Jesper Lagergren
- Division of Cancer Studies, King's College London, Guy's and St Thomas' NHS Foundation Trust, London, UK; Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
| | - Elizabeth Smyth
- Department of Gastrointestinal Oncology, The Royal Marsden NHS Foundation Trust, London, UK
| | - David Cunningham
- Department of Gastrointestinal Oncology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Pernilla Lagergren
- Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
35
|
Chen CY, Hsieh VCR, Chang CH, Chen PR, Liang WM, Pan SC, Shieh SH. Impacts of treatments on the quality of life among esophageal squamous cell carcinoma patients. Dis Esophagus 2017; 30:1-8. [PMID: 28859389 DOI: 10.1093/dote/dox061] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 05/18/2017] [Indexed: 12/11/2022]
Abstract
This study aims to investigate the effects of treatments on the quality of life for patients with esophageal squamous cell carcinoma patients diagnosed at early and late stages. From a medical center in central Taiwan, patients who had been diagnosed with esophageal squamous cell carcinoma from February 2007 and March 2011 were recruited. Using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) and the Quality of Life Questionnaire Oesophageal 18 (QLQ-OES18), quality of life scores for 105 esophageal squamous cell carcinoma patients were obtained and assessed. Multivariate analysis was performed on the quality of life scores after stratification by cancer stage. Among early-stage esophageal squamous cell carcinoma patients, those received only surgery (S-only) performed better in physical and social functioning compared with patients who underwent surgery and concurrent chemoradiotherapy (S+CCRT) (β = 9.0, P = 0.03; β = 12.1, P = 0.04, respectively). For those that received only concurrent chemoradiotherapy (CCRT-only), they performed worse in role and emotional functioning relative to S+CCRT patients (β = -17.2, P = 0.02; β = -15.7, P = 0.05, respectively). Among late-stage patients, CCRT-only treatment gave insignificantly better global health status and functional scale scores and less severe symptoms compared to the S+CCRT option. Better functional scores and less aggravated symptoms are observed in early-stage esophageal squamous cell carcinoma patients who received surgery-only treatment relative to those that underwent both surgery and chemoradiotherapy. For late-stage esophageal cancer patients, the measured difference of quality of life is not significant between CCRT-only and S+CCRT treatments.
Collapse
Affiliation(s)
- C-Y Chen
- Institute of Medicine, Department of Surgery, Chung Shan Medical University, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - V C-R Hsieh
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
| | - C-H Chang
- Department of Physical Medicine and Rehabilitation, and the Beuhler Center on Aging, Health & Society, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Rehabilitation Institute of Chicago, Chicago, Illinois, USA
| | - P-R Chen
- Division of Thoracic Surgery, China Medical University and Hospital, Taichung, Taiwan
| | - W-M Liang
- Graduate Institute of Biostatistics, China Medical University, Taichung, Taiwan
| | - S-C Pan
- Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University, Taipei, Taiwan
| | - S-H Shieh
- Department of Health Services Administration, China Medical University, Taichung, Taiwan.,Department of Nursing, China Medical University Hospital, Taichung, Taiwan
| |
Collapse
|
36
|
van Vulpen JK, Siersema PD, van Hillegersberg R, Nieuwenhuijzen GAP, Kouwenhoven EA, Groenendijk RPR, van der Peet DL, Hazebroek EJ, Rosman C, Schippers CCG, Steenhagen E, Peeters PHM, May AM. Physical ExeRcise Following Esophageal Cancer Treatment (PERFECT) study: design of a randomized controlled trial. BMC Cancer 2017; 17:552. [PMID: 28821284 PMCID: PMC5562993 DOI: 10.1186/s12885-017-3542-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 08/11/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Following esophagectomy, esophageal cancer patients experience a clinically relevant deterioration of health-related quality of life, both on the short- and long-term. With the currently growing number of esophageal cancer survivors, the burden of disease- and treatment-related complaints and symptoms becomes more relevant. This emphasizes the need for interventions aimed at improving quality of life. Beneficial effects of post-operative physical exercise have been reported in several cancer types, but so far comparable evidence in esophageal cancer patients is lacking. The aim of this study is to investigate effects of physical exercise on health-related quality of life in esophageal cancer patients following surgery. METHODS The Physical ExeRcise Following Esophageal Cancer Treatment (PERFECT) study is a multicenter randomized controlled trial including 150 esophageal cancer patients after surgery with curative intent. Patients are randomly allocated to an exercise group or usual care group. The exercise group participates in a 12-week combined aerobic and resistance exercise program, supervised by a physiotherapist near the patient's home-address. In addition, participants in the exercise group are requested to be physically active for at least 30 min per day, every day of the week. Participants allocated to the usual care group are asked to maintain their habitual physical activity pattern. The primary outcome is health-related quality of life (EORTC-QLQ-C30). Secondary outcomes include esophageal cancer specific quality of life, fatigue, anxiety and depression, sleep quality, work-related factors, cardiorespiratory fitness (VO2peak), muscle strength, physical activity, malnutrition risk, anthropometry, blood markers, recurrence of disease and survival. All questionnaire outcomes, diaries and accelerometers are assessed at baseline, post-intervention (12 weeks post-baseline) and 24 weeks post-baseline. Physical fitness, anthropometry and blood markers are assessed at baseline and post-intervention. In addition, adherence and safety are monitored throughout the exercise program. DISCUSSION This randomized controlled trial investigates effects of physical exercise versus usual care in esophageal cancer patients after surgery. As the design of the exercise program closely resembles daily practice, this study can contribute both to evidence on effects of exercise in esophageal cancer patients, and to potential implementation strategies. TRIAL REGISTRATION Trial registration:Netherlands Trial Registry NTR5045 Date of trial registration: January 19th, 2015 Date and version study protocol: February 2017, version 1.
Collapse
Affiliation(s)
- Jonna K van Vulpen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, P.O. Box 85500, STR 6.131, 3508 GA, Utrecht, The Netherlands
| | - Peter D Siersema
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CG, Utrecht, The Netherlands.,Department of Gastroenterology and Hepatology, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Richard van Hillegersberg
- Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CG, Utrecht, The Netherlands
| | - Grard A P Nieuwenhuijzen
- Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | - Ewout A Kouwenhoven
- Department of Surgery, ZGT Hospital, Zilvermeeuw 1, 7609 PP, Almelo, The Netherlands
| | - Richard P R Groenendijk
- Department of Surgery, IJsselland Hospital, Prins Constantijnweg 2, 2906 ZC, Capelle a/d IJssel, The Netherlands
| | - Donald L van der Peet
- Department of Surgery, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Eric J Hazebroek
- Department of Surgery, St. Antonius Hospital, Koekoekslaan 1, 3430 VB, Nieuwegein, The Netherlands
| | - Camiel Rosman
- Department of Surgery, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Carlo C G Schippers
- Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CG, Utrecht, The Netherlands
| | - Elles Steenhagen
- Department of Dietetics, University Medical Center Utrecht, Heidelberglaan 100, 3584 CG, Utrecht, The Netherlands
| | - Petra H M Peeters
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, P.O. Box 85500, STR 6.131, 3508 GA, Utrecht, The Netherlands.,School of Public Health, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK
| | - Anne M May
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, P.O. Box 85500, STR 6.131, 3508 GA, Utrecht, The Netherlands.
| |
Collapse
|
37
|
Gannon JA, Guinan EM, Doyle SL, Beddy P, Reynolds JV, Hussey J. Reduced fitness and physical functioning are long-term sequelae after curative treatment for esophageal cancer: a matched control study. Dis Esophagus 2017; 30:1-7. [PMID: 28575241 DOI: 10.1093/dote/dox018] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 03/07/2017] [Indexed: 12/11/2022]
Abstract
Reduced physical functioning is common following resections for esophageal cancer; however, objective data on physical performance outcomes in this cohort are rare. The aim of this study was to assess the physical performance and health related quality of life (HRQOL) of disease free survivors and compare findings in a case matched noncancer control group. Twenty-five males (mean (±SD) aged 63 (±6) years) who were over 6 months postesophagectomy and disease-free were compared with 25 controls (60 ± 6 years). Physical functioning was assessed through hand grip strength (dynamometry), exercise capacity (incremental shuttle walk test), physical activity levels (RT3 accelerometer), and body composition (bio-electrical impedance analysis). Health-related quality of life was measured using the EORTC QLQ-C30 questionnaire. Esophageal cancer survivors demonstrated significantly lower fitness (P < 0.001) and time spent in moderate (P < 0.001) and vigorous (P < 0.001) intensity physical activity compared with controls. Global health status and quality of life were similar in both groups (P = 0.245); however, physical and role functioning domains were lower in the cancer survivors (P < 0.001, and P = 0.001, respectively). These data show that disease-free survivors of curative esophageal cancer treatment demonstrate a significant compromise in physical functioning compared with controls, thus highlighting the multiple, complex rehabilitative needs of this cohort.
Collapse
Affiliation(s)
- J A Gannon
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - E M Guinan
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - S L Doyle
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | | | - J V Reynolds
- Department of Surgery, St James's Hospital and Trinity College Dublin, Dublin, Ireland
| | - J Hussey
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
| |
Collapse
|
38
|
Abstract
Oesophageal cancer is the sixth most common cause of cancer-related death worldwide and is therefore a major global health challenge. The two major subtypes of oesophageal cancer are oesophageal squamous cell carcinoma (OSCC) and oesophageal adenocarcinoma (OAC), which are epidemiologically and biologically distinct. OSCC accounts for 90% of all cases of oesophageal cancer globally and is highly prevalent in the East, East Africa and South America. OAC is more common in developed countries than in developing countries. Preneoplastic lesions are identifiable for both OSCC and OAC; these are frequently amenable to endoscopic ablative therapies. Most patients with oesophageal cancer require extensive treatment, including chemotherapy, chemoradiotherapy and/or surgical resection. Patients with advanced or metastatic oesophageal cancer are treated with palliative chemotherapy; those who are human epidermal growth factor receptor 2 (HER2)-positive may also benefit from trastuzumab treatment. Immuno-oncology therapies have also shown promising early results in OSCC and OAC. In this Primer, we review state-of-the-art knowledge on the biology and treatment of oesophageal cancer, including screening, endoscopic ablative therapies and emerging molecular targets, and we discuss best practices in chemotherapy, chemoradiotherapy, surgery and the maintenance of patient quality of life.
Collapse
Affiliation(s)
- Elizabeth C. Smyth
- Department of Gastrointestinal Oncology, Royal Marsden Hospital, London & Sutton. United Kingdom
| | - Jesper Lagergren
- Division of Cancer Studies, King's College London, United Kingdom
- Upper Gastrointestinal Surgery, Department of Molecular medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, 17176 Stockholm, Sweden
| | | | - Florian Lordick
- University Cancer Center Leipzig, University Medicine Leipzig, Leipzig, Germany
| | - Manish A. Shah
- Sandra and Edward Meyer Cancer Center at Weill Cornell Medicine, New York-Presbyterian Hospital, New York. United States
| | - Pernilla Lagergren
- Surgical care science, Department of Molecular medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - David Cunningham
- Department of Gastrointestinal Oncology, Royal Marsden Hospital, London & Sutton. United Kingdom
| |
Collapse
|
39
|
Ghelfi J, Brichon PY, Frandon J, Boussat B, Bricault I, Ferretti G, Guigard S, Sengel C. Ischemic Gastric Conditioning by Preoperative Arterial Embolization Before Oncologic Esophagectomy: A Single-Center Experience. Cardiovasc Intervent Radiol 2017; 40:712-720. [PMID: 28050659 DOI: 10.1007/s00270-016-1556-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 12/22/2016] [Indexed: 01/25/2023]
Abstract
PURPOSE Surgical esophagectomy is the gold standard treatment of early-stage esophageal cancer. The procedure is complicated with significant morbidity; the most severe complication being the anastomotic leakage. Anastomotic fistulas are reported in 5-25% of cases and are mainly due to gastric transplant ischemia. Here, we report our experience of ischemic pre-conditioning using preoperative arterial embolization (PreopAE) before esophagectomy. MATERIALS AND METHODS The medical records of all patients who underwent oncologic esophagectomy from 2008 to 2015 were retrospectively reviewed. Patients were divided into two groups: patients who received PreopAE, and a control group of patients who did not benefit from ischemic pre-conditioning. The target arteries selected for PreopAE were the splenic artery, left gastric artery, and right gastric artery. Evaluation of the results was based on anastomotic leakage, postoperative mortality, technical success of PreopAE, and complications related to the embolization procedure. RESULTS Forty-six patients underwent oncologic esophagectomy with PreopAE and 13 patients did not receive ischemic conditioning before surgery. Thirty-eight PreopAE were successfully performed (83%), but right gastric artery embolization failed for 8 patients. Anastomotic leakage occurred in 6 PreopAE patients (13%) and in 6 patients (46%) in the control group (p = 0.02). The mortality rate was 2% in the PreopAE group and 23% in the control group (p = 0.03). Eighteen patients suffered from partial splenic infarction after PreopAE, all treated conservatively. CONCLUSION Preoperative ischemic conditioning by arterial embolization before oncologic esophagectomy seems to be effective in preventing anastomotic leakage.
Collapse
Affiliation(s)
- Julien Ghelfi
- Clinique Universitaire de Radiologie et Imagerie Médicale, CHU de Grenoble, BP 217, 38043, Grenoble Cedex 09, France.
| | - Pierre-Yves Brichon
- Clinique Universitaire de Chirurgie Thoracique, Vasculaire et Endocrinienne, CHU de Grenoble, BP 217, 38043, Grenoble Cedex 09, France
| | - Julien Frandon
- Clinique Universitaire de Radiologie et Imagerie Médicale, CHU de Nîmes, 30029, Nîmes Cedex 09, France
| | - Bastien Boussat
- Département d'Information Médicale, Pôle de Santé Publique, CHU de Grenoble, BP 217, 38043, Grenoble Cedex 09, France
| | - Ivan Bricault
- Clinique Universitaire de Radiologie et Imagerie Médicale, CHU de Grenoble, BP 217, 38043, Grenoble Cedex 09, France
| | - Gilbert Ferretti
- Clinique Universitaire de Radiologie et Imagerie Médicale, CHU de Grenoble, BP 217, 38043, Grenoble Cedex 09, France
| | - Sébastien Guigard
- Clinique Universitaire de Chirurgie Thoracique, Vasculaire et Endocrinienne, CHU de Grenoble, BP 217, 38043, Grenoble Cedex 09, France
| | - Christian Sengel
- Clinique Universitaire de Radiologie et Imagerie Médicale, CHU de Grenoble, BP 217, 38043, Grenoble Cedex 09, France
| |
Collapse
|
40
|
Haj Mohammad N, De Rooij S, Hulshof M, Ruurda J, Wijnhoven B, Erdkamp F, Sosef M, Gisbertz S, van Berge Henegouwen M, Sprangers M, van Laarhoven H. Activities of daily living and quality of life during treatment with neoadjuvant chemoradiotherapy and after surgery in patients with esophageal cancer. J Surg Oncol 2016; 114:684-690. [DOI: 10.1002/jso.24378] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 07/06/2016] [Indexed: 12/22/2022]
Affiliation(s)
- Nadia Haj Mohammad
- Department of Medical Oncology; Academic Medical Center; Amsterdam The Netherlands
- Department of Medical Oncology; University Medical Center Utrecht; Utrecht The Netherlands
| | - Sophia De Rooij
- Department of Internal Medicine; Section of Geriatric Medicine; Academic Medical Center Groningen; Groningen The Netherlands
- Department of Internal Medicine; Section of Geriatric Medicine; Academic Medical Center; Amsterdam The Netherlands
| | - Maarten Hulshof
- Department of Radiation Oncology; Academic Medical Center; Amsterdam The Netherlands
| | - Jelle Ruurda
- Department of Surgery; University Medical Center Utrecht; Utrecht The Netherlands
| | - Bas Wijnhoven
- Department of Surgery; Erasmus MC; University Medical Center Rotterdam; Rotterdam The Netherlands
| | - Frans Erdkamp
- Department of Internal Medicine; Zuyderland Medisch Centrum; Heerlen/Sittard/Geleen The Netherlands
| | - Meindert Sosef
- Department of Surgery; Zuyderland Medisch Centrum; Heerlen/Sittard/Geleen The Netherlands
| | - Suzanne Gisbertz
- Department of Surgery; Academic Medical Center; Amsterdam The Netherlands
| | | | - Mirjam Sprangers
- Department of Medical Psychology; Academic Medical Center; Amsterdam The Netherlands
| | | |
Collapse
|
41
|
Straatman J, Joosten PJM, Terwee CB, Cuesta MA, Jansma EP, van der Peet DL. Systematic review of patient-reported outcome measures in the surgical treatment of patients with esophageal cancer. Dis Esophagus 2016; 29:760-772. [PMID: 26471471 DOI: 10.1111/dote.12405] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Esophageal cancer is currently the eighth most common cancer worldwide. Improvements in operative techniques and neoadjuvant therapies have led to improved outcomes. Resection of the esophagus carries a high risk of severe complications and has a negative impact on health-related quality of life (QOL). The aim of this study was to assess which patient-reported outcome measures (PROMs) are used to measure QOL after esophagectomy for cancer. A comprehensive search of original articles was conducted investigating QOL after surgery for esophageal carcinoma. Two authors independently selected relevant articles, conducted clinical appraisal, and extracted data (PJ and JS). Out of 5893 articles, 58 studies were included, consisting of 41 prospective and 17 retrospective cohort studies, including a total of 6964 patients. These studies included 11 different PROMs. The existing PROMs could be divided into generic, symptom-specific, and disease-specific questionnaires. The European Organisation for Research and Treatment of Cancer (EORTC) QOL Questionnaire Core 30 (QLQ C-30) along with the EORTC QLQ-OESophagus module OES18 was the most widely used; in 42 and 32 studies, respectively. The EORTC and the Functional Assessment of Cancer Therapy (FACT) questionnaires use an oncological module and an organ-specific module. One validation study was available, which compared the FACT and EORTC, showing moderate to poor correlation between the questionnaires. A great variety of PROMs are being used in the measurement of QOL after surgery for esophageal cancer. A questionnaire with a general module along with a disease-specific module for assessment of QOL of different treatment modalities seem to be the most desirable, such as the EORTC and the FACT with their specific modules (EORTC QLQ-OES18 and FACT-E). Both are developed in different treatment modalities, such as in surgical patients. With regard to reproducibility of current results, the EORTC is recommended.
Collapse
Affiliation(s)
- J Straatman
- Departments of Gastrointestinal Surgery, VU University Medical Center, Amsterdam, The Netherlands.
| | - P J M Joosten
- Departments of Gastrointestinal Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - C B Terwee
- Departments of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - M A Cuesta
- Departments of Gastrointestinal Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - E P Jansma
- Medical library, VU University Medical Center, Amsterdam, The Netherlands
| | - D L van der Peet
- Departments of Gastrointestinal Surgery, VU University Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
42
|
Sunde B, Ericson J, Kumagai K, Lundell L, Tsai JA, Lindblad M, Rouvelas I, Friesland S, Wang N, Nilsson M. Relief of dysphagia during neoadjuvant treatment for cancer of the esophagus or gastroesophageal junction. Dis Esophagus 2016; 29:442-7. [PMID: 25809837 DOI: 10.1111/dote.12352] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Dysphagia is the main symptom of cancer of the esophagus and gastroesophageal junction and causing nutritional problems and weight loss, often counteracted by insertion of self-expandable metal stents or nutrition via an enteral route. Clinical observations indicate that neoadjuvant therapy may effectively and promptly alleviate dysphagia, making such nutrition supportive interventions redundant before surgical resection. The objective of the current study was to carefully study the effects of induction neoadjuvant therapy on dysphagia and its subsequent course and thereby investigate the actual need for alimentary gateways for nutritional support. Thirty-five consecutive patients scheduled for neoadjuvant therapy were recruited and assessed regarding dysphagia and appetite at baseline, after the first cycle of preoperative treatment with either chemotherapy alone or with chemoradiotherapy and before surgery. Platinum-based therapy in combination with 5-fluorouracil was administered intravenously days 1-5 every 3 weeks and consisted of three treatments. Patients receiving combined chemoradiotherapy started radiotherapy on day one of second chemotherapy cycle. They received fractions of 2 Gy/day each up to a total dose of 40 Gy. Watson and Ogilvie dysphagia scores were used to assess dysphagia, while appetite was assessed by the Edmonton Assessment System Visual analogue scale-appetite questionnaire. Patients were evaluated at regular outpatient clinic visits or by telephone. The histological tumor response in the surgical specimen was assessed using the Chirieac scale. Ten patients scheduled for neoadjuvant chemotherapy and 25 patients scheduled for chemoradiotherapy were included in the analysis. There was a significant improvement in dysphagia in both treatment groups, according to both scales, already from baseline to the completion of the first chemotherapy cycle which remained to the end of the neoadjuvant treatment (P < 0.001). Appetite also improved after the first chemotherapy cycle (P = 0.03). Body weight did not change during any type of neoadjuvant therapy. We were unable to demonstrate any association between relief of dysphagia and the degree of histological response to neoadjuvant therapy in the surgical specimen. The present study shows that a platin - 5FU-based neoadjuvant chemotherapy, with or without concomitant radiotherapy, effectively and promptly relieves dysphagia in patients presenting with cancers of the esophagus or gastroesophageal junction already after the first cycle.
Collapse
Affiliation(s)
- B Sunde
- Division of Surgery, Department of Clinical Science, Technology and Intervention (CLINTEC), Karolinska Institutet, Stockholm, Sweden.,Department of Surgery, Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - J Ericson
- Division of Surgery, Department of Clinical Science, Technology and Intervention (CLINTEC), Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Nutrition and Dietetics, Karolinska University Hospital, Stockholm, Sweden
| | - K Kumagai
- Department of Surgery, Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - L Lundell
- Division of Surgery, Department of Clinical Science, Technology and Intervention (CLINTEC), Karolinska Institutet, Stockholm, Sweden.,Department of Surgery, Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - J A Tsai
- Division of Surgery, Department of Clinical Science, Technology and Intervention (CLINTEC), Karolinska Institutet, Stockholm, Sweden.,Department of Surgery, Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - M Lindblad
- Division of Surgery, Department of Clinical Science, Technology and Intervention (CLINTEC), Karolinska Institutet, Stockholm, Sweden.,Department of Surgery, Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - I Rouvelas
- Division of Surgery, Department of Clinical Science, Technology and Intervention (CLINTEC), Karolinska Institutet, Stockholm, Sweden.,Department of Surgery, Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - S Friesland
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden.,Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - N Wang
- Department of Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - M Nilsson
- Division of Surgery, Department of Clinical Science, Technology and Intervention (CLINTEC), Karolinska Institutet, Stockholm, Sweden.,Department of Surgery, Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
43
|
Heethuis SE, van Rossum PSN, Lips IM, Goense L, Voncken FE, Reerink O, van Hillegersberg R, Ruurda JP, Philippens ME, van Vulpen M, Meijer GJ, Lagendijk JJW, van Lier ALHMW. Dynamic contrast-enhanced MRI for treatment response assessment in patients with oesophageal cancer receiving neoadjuvant chemoradiotherapy. Radiother Oncol 2016; 120:128-35. [PMID: 27296409 DOI: 10.1016/j.radonc.2016.05.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 04/22/2016] [Accepted: 05/12/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE To explore and evaluate the potential value of dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) for the prediction of pathologic response to neoadjuvant chemoradiotherapy (nCRT) in oesophageal cancer. MATERIAL AND METHODS Twenty-six patients underwent DCE-MRI before, during (week 2-3) and after nCRT, but before surgery (pre/per/post, respectively). Histopathologic tumour regression grade (TRG) was assessed after oesophagectomy. Tumour area-under-the-concentration time curve (AUC), time-to-peak (TTP) and slope were calculated. The ability of these DCE-parameters to distinguish good responders (GR, TRG 1-2) from poor responders (noGR, TRG⩾3), and pathologic complete responders (pCR) from no-pCR was assessed. RESULTS Twelve patients (48%) showed GR of which 8 patients (32%) pCR. Analysis of AUC change throughout treatment, AUCper-pre, was most predictive for GR, at a threshold of 22.7% resulting in a sensitivity of 92%, specificity of 77%, PPV of 79%, and a NPV of 91%. AUCpost-pre was most predictive for pCR, at a threshold of -24.6% resulting in a sensitivity of 83%, specificity of 88%, PPV of 71%, and a NPV of 93%. TTP and slope were not associated with pathologic response. CONCLUSIONS This study demonstrates that changes in AUC throughout treatment are promising for prediction of histopathologic response to nCRT for oesophageal cancer.
Collapse
Affiliation(s)
- Sophie E Heethuis
- Department of Radiotherapy, University Medical Center Utrecht, Netherlands.
| | - Peter S N van Rossum
- Department of Radiotherapy, University Medical Center Utrecht, Netherlands; Department of Surgery, University Medical Center Utrecht, Netherlands
| | - Irene M Lips
- Department of Radiotherapy, University Medical Center Utrecht, Netherlands
| | - Lucas Goense
- Department of Radiotherapy, University Medical Center Utrecht, Netherlands; Department of Surgery, University Medical Center Utrecht, Netherlands
| | - Francine E Voncken
- Department of Radiotherapy, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - Onne Reerink
- Department of Radiotherapy, University Medical Center Utrecht, Netherlands
| | | | - Jelle P Ruurda
- Department of Surgery, University Medical Center Utrecht, Netherlands
| | | | - Marco van Vulpen
- Department of Radiotherapy, University Medical Center Utrecht, Netherlands
| | - Gert J Meijer
- Department of Radiotherapy, University Medical Center Utrecht, Netherlands
| | - Jan J W Lagendijk
- Department of Radiotherapy, University Medical Center Utrecht, Netherlands
| | | |
Collapse
|
44
|
Kathiravetpillai N, Koëter M, van der Sangen MJC, Creemers GJ, Luyer MDP, Rutten HJT, Nieuwenhuijzen GAP. Delaying surgery after neoadjuvant chemoradiotherapy does not significantly influence postoperative morbidity or oncological outcome in patients with oesophageal adenocarcinoma. Eur J Surg Oncol 2016; 42:1183-90. [PMID: 27134188 DOI: 10.1016/j.ejso.2016.03.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Revised: 02/13/2016] [Accepted: 03/31/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Patients with resectable oesophageal cancer are treated with neoadjuvant chemoradiotherapy (nCRT) followed by surgery within 3-8 weeks. In practice, surgery is often delayed for various reasons. The aim of this study was to evaluate whether delaying surgery beyond 8 weeks has an effect on postoperative morbidity, long-term survival, and pathologic response in patients treated for oesophageal ADC. METHODS Patients who underwent nCRT followed by surgery, for cT1-3, N0-3, M0 ADC between 2001 and 2014 were retrospectively included from a prospectively obtained database. Patients with a time from the end of nCRT to surgery (TTS) ≤8 weeks were compared with patients with a TTS >8 weeks. RESULTS Of 190 patients, 65 had a TTS ≤8 weeks, and 125 had a TTS >8 weeks. Patient characteristics were comparable for both groups, but patients with TTS >8 weeks exhibited higher ASA scores (p = 0.013) and more comorbidities (p = 0.007). Multivariate analysis revealed that TTS did not significantly influence postoperative morbidity, pathologic complete response rates, and five-year survival rates (42% in patients with TTS ≤8 weeks and 37% in patients with TTS >8 weeks). CONCLUSIONS Delaying surgery beyond 8 weeks after nCRT did not significantly influence postoperative morbidity, pathologic response, and survival in patients with non-metastatic ADC. Therefore, it appears reasonable to postpone surgery beyond 8 weeks in patients who have not yet recovered from nCRT. However, if the patient is fit for surgery, postponing surgery does not have any additional advantages.
Collapse
Affiliation(s)
| | - M Koëter
- Department of Surgery, Catharina Hospital Eindhoven, The Netherlands
| | | | - G J Creemers
- Department of Oncology, Catharina Hospital Eindhoven, The Netherlands
| | - M D P Luyer
- Department of Surgery, Catharina Hospital Eindhoven, The Netherlands
| | - H J T Rutten
- Department of Surgery, Catharina Hospital Eindhoven, The Netherlands
| | | |
Collapse
|
45
|
Rees J, Hurt CN, Gollins S, Mukherjee S, Maughan T, Falk SJ, Staffurth J, Ray R, Bashir N, Geh JI, Cunningham D, Roy R, Bridgewater J, Griffiths G, Nixon LS, Blazeby JM, Crosby T. Patient-reported outcomes during and after definitive chemoradiotherapy for oesophageal cancer. Br J Cancer 2015; 113:603-10. [PMID: 26203761 PMCID: PMC4647690 DOI: 10.1038/bjc.2015.258] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 05/07/2015] [Accepted: 06/15/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Limited data describe patient-reported outcomes (PROs) of localised oesophageal cancer treated with definitive chemoradiotherapy(CRT). The phase 2/3 SCOPE-1 trial assessed the effectiveness of CRT±cetuximab. The trial for the first time provided an opportunity to describe PROs from a multi-centre group of patients treated with CRT that are presented here. METHODS Patients undergoing CRT±cetuximab within the SCOPE-1 trial (258 patients from 36 UK centres) completed generic-, disease- and treatment-specific health-related quality of life (HRQL) questionnaires (EORTC QLQ-C30, QLQ-OES18, Dermatology Life-Quality Index (DLQI)) at baseline and at 7, 13, 24, 52 and 104 weeks. Mean EORTC functional scale scores (>15 point change significant), DLQI scores (>4 point change significant) and proportions of patients (>15% significant) with 'minimal' or 'severe' symptoms are presented. RESULTS Questionnaire response rates were good. At baseline, EORTC functional scores were high (>75%) and few symptoms were reported except for severe problems with fatigue, insomnia and eating-related symptoms (e.g., appetite loss, dysphagia, dry mouth) in both groups(>15%). Functional aspects of health deteriorated and symptoms increased with treatment and by week 13 global quality of life, physical, role and social function significantly deteriorated and more problems with fatigue, dyspnoea, appetite loss and trouble with taste were reported. Recovery occurred by 6 months (except severe fatigue and insomnia in >15% of patients) and maintained at follow-up with no differences between groups. CONCLUSIONS CRT for localised oesophageal cancer has a significant detrimental impact on many aspects of HRQL; however, recovery is achieved by 6 months and maintained with the exception of persisting problems with severe fatigue and insomnia. The data suggest that the HRQL recovery after definitive CRT is quicker, and there is little lasting deficit compared with treatment including surgery. These data need to be compared with HRQL data from studies evaluating treatments including surgery for oesophageal cancer.
Collapse
Affiliation(s)
- J Rees
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
- Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - C N Hurt
- Wales Cancer Trials Unit, School of Medicine, Cardiff University, Cardiff, UK
| | - S Gollins
- North Wales Cancer Treatment Centre, Glan Clwyd Hospital, Rhyl, North Wales, UK
| | - S Mukherjee
- CRUK/MRC Oxford Institute for Radiation Oncology, Oxford University, Oxford, UK
| | - T Maughan
- CRUK/MRC Oxford Institute for Radiation Oncology, Oxford University, Oxford, UK
| | - S J Falk
- Bristol Haematology and Oncology Centre, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - J Staffurth
- Institute of Cancer and Genetics, School of Medicine, Cardiff University, Cardiff, UK
| | - R Ray
- Wales Cancer Trials Unit, School of Medicine, Cardiff University, Cardiff, UK
| | - N Bashir
- Wales Cancer Trials Unit, School of Medicine, Cardiff University, Cardiff, UK
| | - J I Geh
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Queen Elizabeth Medical Centre, Birmingham, UK
| | - D Cunningham
- The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - R Roy
- Queen's Centre for Oncology and Haematology, Hull and East Yorkshire NHS Trust, Hull, UK
| | | | - G Griffiths
- Wales Cancer Trials Unit, School of Medicine, Cardiff University, Cardiff, UK
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - L S Nixon
- Wales Cancer Trials Unit, School of Medicine, Cardiff University, Cardiff, UK
| | - J M Blazeby
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
- Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - T Crosby
- Velindre Cancer Centre, Velindre Hospital, Cardiff, UK
| |
Collapse
|
46
|
Quality-of-life measures as predictors of post-esophagectomy survival of patients with esophageal cancer. Qual Life Res 2015; 25:465-475. [DOI: 10.1007/s11136-015-1094-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2015] [Indexed: 11/26/2022]
|
47
|
Dietary alterations and restrictions following surgery for upper gastrointestinal cancers: Key components of a health-related quality of life intervention. Eur J Oncol Nurs 2015; 19:343-8. [PMID: 25697545 DOI: 10.1016/j.ejon.2015.01.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 01/14/2015] [Accepted: 01/22/2015] [Indexed: 12/31/2022]
Abstract
PURPOSE The surgical treatment of upper gastrointestinal (GI) cancers, specifically esophageal and gastric cancers, often result in extensive health-related quality of life (HRQOL) concerns, particularly those associated with dietary adjustments. This paper provides a review of HRQOL changes following esophagectomy and gastrectomy, and describes key components of an intervention to improve dietary adjustments following surgery. METHODS Intervention development was informed by 1) current published evidence on HRQOL changes for patients following upper GI surgery, 2) examination of usual post-operative care related to dietary restrictions to identify areas for continued education and support and 3) the inclusion of a conceptual framework (the Chronic Care Model) to guide intervention design and inform the selection of appropriate outcome measures. RESULTS Three key components of an HRQOL intervention are identified, and should focus on HRQOL concerns associated with dietary alterations and restrictions following treatment, involve family caregivers, and be tailored and flexible to patient and family caregiver's needs and preferences. CONCLUSIONS Evidence-based interventions to support long-term dietary alterations and restrictions following upper GI surgery are lacking, despite evidence confirming its impact on morbidity and mortality. Interventions are needed to support dietary adjustments, prevent malnutrition and excessive weight loss, and enhance HRQOL following surgery for upper GI cancers.
Collapse
|
48
|
Wen Y, Pan XF, Huang WZ, Zhao ZM, Wei WQ, Chen F, Lan H, Huang H, Yang CX, Qiao YL. Quality of life for patients with esophageal/gastric cardia precursor lesions or cancer: a one-year prospective study. Asian Pac J Cancer Prev 2015; 16:45-51. [PMID: 25640389 DOI: 10.7314/apjcp.2015.16.1.45] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The current study examined health-related quality of life (QoL) for patients with esophageal/ gastric cardia precursor lesions or cancer before and after treatment to facilitate improved prevention and treatment. MATERIALS AND METHODS Patients with different stages of esophageal/gastric cardia lesions completed two QoL questionnaires, EORTC QLQ-C30 and supplemental QLQ-OES 18, before primary treatment, and at 1, 6 and 12 months after treatment. RESULTS Fifty-nine patients with precursor lesions, 57 with early stage cancer, and 43 with advanced cancer responded to our survey. Patients with precursor lesions or early stage cancer reported better QoL overall than those with advanced cancer before treatment (p<0.01). Global QoL scores before treatment and at 1 month after treatment were 71±9 versus 69±9 (p>0.01), 71±8 versus 61±11 (p<0.01), 67 ± 11 versus 62 ± 9 (p<0.01) for three stages of lesions. At 6 months after treatment, some QoL measures recovered gradually in precursor lesion and early cancer patients, while some continuously deteriorated in advanced cancer patients. At 12 months, all QoL scores were comparable to baseline for patients with precursor lesions (p>0.01), while global QoL, social, pain, and insomnia scores for early stage and advanced cancer were inferior to corresponding baseline levels (difference between means>5, p<0.01). At this time point, compared with patients with early stage cancer, those with advanced cancer showed worse QoL with all function and most symptom measures (p<0.01). CONCLUSIONS Patients with precursor lesions or early stage esophageal/gastric cardia cancer show better QoL than those with advanced cancer. This indicates that screening, early diagnosis and treatment may improve the QoL for esophageal/gastric cardia cancer patients. Target intervention and counseling should be given by health care providers during treatment and follow-up to facilitate QoL improvement.
Collapse
Affiliation(s)
- Ying Wen
- Department of Epidemiology, West China School of Public Health, Sichuan University, Chengdu, China E-mail :
| | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Cools-Lartigue J, Jones D, Spicer J, Zourikian T, Rousseau M, Eckert E, Alcindor T, Vanhuyse M, Asselah J, Ferri LE. Management of Dysphagia in Esophageal Adenocarcinoma Patients Undergoing Neoadjuvant Chemotherapy: Can Invasive Tube Feeding be Avoided? Ann Surg Oncol 2014; 22:1858-65. [DOI: 10.1245/s10434-014-4270-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Indexed: 12/17/2022]
|
50
|
Duan XF, Tang P, Yu ZT. Neoadjuvant chemoradiotherapy for resectable esophageal cancer: an in-depth study of randomized controlled trials and literature review. Cancer Biol Med 2014; 11:191-201. [PMID: 25364580 PMCID: PMC4197424 DOI: 10.7497/j.issn.2095-3941.2014.03.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 06/19/2014] [Indexed: 12/15/2022] Open
Abstract
Surgery following neoadjuvant chemoradiotherapy (NCRT) is a common multidisciplinary treatment for resectable esophageal cancer (EC). After analyzing 12 randomized controlled trials (RCTs), we discuss the key issues of surgery in the management of resectable EC. Along with chemoradiotherapy, NCRT is recommended for patients with squamous cell carcinoma (SCC) and adenocarcinoma (AC), and most chemotherapy regimens are based on cisplatin, fluorouracil (FU), or both (CF). However, taxane-based schedules or additional studies, together with newer chemotherapies, are warranted. In nine clinical trials, post-operative complications were similar without significant differences between two treatment groups. In-hospital mortality was significantly different in only 1 out of 10 trials. Half of the randomized trials that compare NCRT with surgery in EC demonstrate an increase in overall survival or disease-free survival. NCRT offers a great opportunity for margin negative resection, decreased disease stage, and improved loco-regional control. However, NCRT does not affect the quality of life when combined with esophagectomy. Future trials should focus on the identification of optimum regimens and selection of patients who are most likely to benefit from specific treatment options.
Collapse
Affiliation(s)
- Xiao-Feng Duan
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, China
| | - Peng Tang
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, China
| | - Zhen-Tao Yu
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, China
| |
Collapse
|