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Andreasen TK, Boje IR, Tolstrup LK, Missel M, Larsen MK. Treatment and Rehabilitation for Esophageal Cancer-Striving to Meet Obstacles and Long-term Impacts: A Qualitative Descriptive Study. Cancer Nurs 2024:00002820-990000000-00242. [PMID: 38625759 DOI: 10.1097/ncc.0000000000001359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2024]
Abstract
BACKGROUND Following esophagogastric cancer treatment, patients with esophageal cancer and their relatives struggle with adjusting to a new everyday life as they experience various challenges after treatment requiring rehabilitation. Health professionals must address long-term impacts on patients' health, everyday life, family functioning, and support needs. OBJECTIVE This qualitative descriptive study aimed to explore patients', relatives', and health professionals' experience with long-term impacts and rehabilitation after treatment for esophageal cancer. METHODS A qualitative approach based on a phenomenological-hermeneutical methodology was used. Two methods were selected in the study: focus group interviews with health professionals and individual interviews with patients and relatives. Inductive thematic analysis with inspiration from Braun and Clarke was used for data analysis. RESULTS Three main themes emerged from the data analysis: (1) forced into limitations in everyday life, (2) learning and navigating a new everyday life, and (3) rehabilitation accepting new normality. CONCLUSION Patients and relatives experience persistent long-term impacts after treatment for esophageal cancer, making rehabilitation strenuous and demanding. Relatives take considerable responsibility for the patients' rehabilitation but feel invisible and unsupported by health professionals. Health professionals acknowledge the severity of long-term impacts but fail to prepare patients and relatives for the impacts and do not see the relatives' need for support. IMPLICATIONS FOR PRACTICE The study emphasizes the need for a proactive approach in the healthcare system, addressing patients' and relatives' physical and psychological vulnerability. Cancer nurses need to prepare and involve patients and relatives in treatment, long-term impacts, and rehabilitation.
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Affiliation(s)
- Trine Kromann Andreasen
- Author Affiliations: Department of Cardiology, Odense University Hospital, Odense, Denmark (Ms Andreasen); Department of Health, Region of Southern Denmark, Vejle, Denmark (Ms Boje); Department of Oncology, Odense University Hospital, Odense, Denmark (Dr Tolstrup); Institute of Clinical Research, University of Southern Denmark, Odense, Denmark (Drs Tolstrup and Larsen); Department of Cardiothoracic Surgery, Copenhagen University Hospital, Copenhagen, Denmark (Dr Missel); Department of Surgery, Odense University Hospital, Odense, Denmark (Dr Larsen)
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Gamm S, Ummel D, Vasil N, Grenier S. Getting Insight to the Lived Emotional Experience of People with Alzheimer's Disease Shortly After Diagnosis: A Phenomenological Approach. J Alzheimers Dis 2024; 99:1129-1145. [PMID: 38788071 DOI: 10.3233/jad-231403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
Background A diagnosis of Alzheimer's disease (AD) is a crucial moment in an individual's existence and represents a major life change that often results in psychological distress, diminish of perceived quality of life, and loss of independence. It is important to better understand the emotional experience of people with dementia to intervene according to their specific needs. Objective The aim of the research was to get insight to the emotional experience of people with AD shortly after its discovery and the consequences thereof. Methods A qualitative exploratory design was engaged, and in-depth interviews were conducted with ten French-speaking participants over 70 years recently diagnosed. Interviews were guided by Heideggerian phenomenology about movements in the worldview of individuals. The transcribed data was subjected to interpretative phenomenological analysis. Results Following the diagnosis, participants experienced either shock or denial. Emotions felt were unpleasant and disturbing for most of them. Especially when participants were confronted with news concerning the illness, they experienced incomprehension. They engaged in an oscillatory motion of connection and disconnection to establish new meanings of their worldview. Thinking about the past seemed to diminish their worries, to reinforce the possibility to fulfil a significant place in their existence and to maintain their autonomy. Conclusions When participants could express their emotional experience and their concerns, they regained a sense of control in their life that seemed du reduce their distress. With this insight, intervention could be adapted to the specific needs of people with AD to enhance their self-determination and quality of life.
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Affiliation(s)
- Simone Gamm
- University of Montréal, Montréal, QC, Canada
- Research Centre of the University Institute of Geriatrics of Montréal (CRIUGM), Montréal, QC, Canada
| | | | - Nancy Vasil
- Research Centre of the University Institute of Geriatrics of Montréal (CRIUGM), Montréal, QC, Canada
| | - Sébastien Grenier
- University of Montréal, Montréal, QC, Canada
- Research Centre of the University Institute of Geriatrics of Montréal (CRIUGM), Montréal, QC, Canada
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Larsen MK, Schultz H, Mortensen MB, Birkelund R. Decision making in the oesophageal cancer trajectory a source of tension and edginess to patients and relatives: a qualitative study. Int J Qual Stud Health Well-being 2023; 18:2170018. [PMID: 36727528 PMCID: PMC9897738 DOI: 10.1080/17482631.2023.2170018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The curative oesophageal cancer continuum-diagnosis, treatment and survivorship represents different phases with its own challenges for the involved parties. The process of treatment decisions and interactions between patients with oesophageal cancer (EC), relatives and health professionals is vital yet not well described. The purpose of the study was to explore patients' and relatives' experiences with the process of decision-making through the EC illness and treatment trajectory. METHODS Longitudinal explorative design was employed based on ethnographic fieldwork in the form of participant observations inspired by the American anthropologist James Spradley. RESULTS Sixteen patients and 18 relatives were recruited for participant observations. In total, 184 hours of participant observations were conducted. The study showed that decision-making was filled with tension and edginess. Four themes were identified: 1) The encounter with the medical authority, 2) The need to see the big picture in the treatment trajectory, 3) A predetermined treatment decision, and 4) Meeting numerous different health professionals. CONCLUSION The EC trajectory and decision-making were filled with anxiety. Patients and relatives lacked an overview of the treatment pathway, leading to their role in decision-making often being governed by the medical authority. Timing information and continuity are vital factors in decision-making.
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Affiliation(s)
- Malene Kaas Larsen
- Department of Surgery, Odense University Hospital, Odense, Denmark,Institute of Clinical Research, University of Southern Denmark, Odense M, Denmark,CONTACT Malene Kaas Larsen Department of Surgery, Odense University Hospital, J.B. Winsløws Vej 4, Odense C5000, Denmark
| | - Helen Schultz
- Department of Surgery, Odense University Hospital, Odense, Denmark,Institute of Clinical Research, University of Southern Denmark, Odense M, Denmark
| | - Michael Bau Mortensen
- Department of Surgery, Odense University Hospital, Odense, Denmark,Institute of Clinical Research, University of Southern Denmark, Odense M, Denmark
| | - Regner Birkelund
- Health Services Research Unit, Lillebaelt Hospital, Vejle, Denmark,Institute of Regional Health Research, University of Southern Denmark, Odense M, Denmark
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Ma X, Ge H, Zhang X, Li S. Survival experience of patients undergoing oesophagectomy during the recovery period: A meta-synthesis of qualitative studies. J Clin Nurs 2023; 32:5579-5595. [PMID: 36802111 DOI: 10.1111/jocn.16648] [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: 09/28/2022] [Revised: 12/28/2022] [Accepted: 01/12/2023] [Indexed: 02/20/2023]
Abstract
AIMS AND OBJECTIVE To systematically review and synthesise existing qualitative research evidence describing the survival experience of patients undergoing oesophagectomy during recovery. BACKGROUND Patients with oesophageal cancer undergoing surgical treatment have severe physical and psychological burdens during the recovery period. Qualitative studies on the survival experience of patients undergoing oesophagectomy are increasing annually, but there is no integration of qualitative evidence. DESIGN A systematic review and synthesis of qualitative studies were conducted following the ENTREQ. METHODS Five English (CINAHL, Embase, PubMed, Web of Science and Cochrane Library) and three Chinese (Wanfang, CNKI and VIP) databases were searched for literature on the survival of patients undergoing oesophagectomy during the recovery period from its establishment in April 2022. The quality of the literature was evaluated by the 'Qualitative Research Quality Evaluation Criteria for the JBI Evidence-Based Health Care Centre in Australia', and the data were synthesised by the thematic synthesis method of Thomas and Harden. RESULTS A total of 18 studies were included, and four themes were identified: physical and mental dual challenges, impaired social functioning, efforts to return to normal life, lack of knowledge and skills in post-discharge care, and thirst for external support. CONCLUSIONS Future research should focus on the problem of reduced social interaction during the recovery of patients with oesophageal cancer, formulating individualised exercise intervention programs and establishing a sound social support system. RELEVANCE TO CLINICAL PRACTICE The results of this study provide evidence-based support for nurses to carry out targeted interventions and reference methods for patients with oesophageal cancer to rebuild their lives. NO PATIENT OR PUBLIC CONTRIBUTION The report was a systematic review and did not involve a population study.
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Affiliation(s)
- Xuanxuan Ma
- School of Nursing, Anhui Medical University, Hefei, China
| | - Hui Ge
- School of Nursing, Anhui Medical University, Hefei, China
| | - Xue Zhang
- School of Nursing, Anhui Medical University, Hefei, China
| | - Shuwen Li
- School of Nursing, Anhui Medical University, Hefei, China
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Murphy CF, Fanning M, Raftery N, Elliott JA, Docherty NG, Donohoe CL, Ravi N, le Roux CW, Reynolds JV. Early experience with a nutrition and survivorship clinic in esophageal cancer. Dis Esophagus 2021; 34:5860595. [PMID: 32566939 DOI: 10.1093/dote/doaa061] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/24/2020] [Accepted: 05/28/2020] [Indexed: 12/11/2022]
Abstract
Improved cure rates in esophageal cancer care have increased focus on health-related quality of life (HRQL) in survivorship. To optimize recovery after esophagectomy, particularly nutritional well-being, a personalized multidisciplinary survivorship clinic was established at this center. Assessments at 6 and 12 months postoperatively include validated European Organization for the Research and Treatment of Cancer (EORTC) symptom and health-related quality of life (HRQL) questionnaires, functional status review, anthropometry, and biochemical screening for micronutrient deficiencies. 75 patients, at a mean age of 63 years, 84% male, 85% with adenocarcinoma, and 73% receiving multimodal therapy were included. Mean preoperative body mass index (BMI) was 27.5 (4.3) kg m -2. 6- and 12-month assessments were completed by 66 (88%) and 37 (93%) recurrence-free patients, respectively. Mean body weight loss at 6 months was 8.5 ± 6.6% and at 12 months 8.8 ± 7.3%. Of the 12-month cohort, micronutrient deficiency was present in 27 (79.4%) preoperatively and 29 (80.6%) after 1 year (P = 0.727), most commonly iron deficiency (preoperative: 16 [43.2%] and postoperative: 17 [45.9%] patients, P = 0.100). 26 (70.3%) of these patients also had clinically significant dumping syndrome persisting to 12 months after surgery. We describe a novel follow-up support structure for esophageal cancer patients in the first year of survivorship. This may serve as an exemplar model with parallel application across oncological care.
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Affiliation(s)
- Conor F Murphy
- National Center for Esophageal and Gastric Cancer, Department of Surgery, Trinity Centre for Health Sciences, Trinity College Dublin and St. James's Hospital, Dublin, Ireland.,Diabetes Complications Research Centre, Conway Institute for Biomedical Science, University College Dublin, Dublin, Ireland
| | - Michelle Fanning
- Department of Clinical Nutrition, St James's Hospital, Dublin, Ireland
| | - Nicola Raftery
- National Center for Esophageal and Gastric Cancer, Department of Surgery, Trinity Centre for Health Sciences, Trinity College Dublin and St. James's Hospital, Dublin, Ireland
| | - Jessie A Elliott
- National Center for Esophageal and Gastric Cancer, Department of Surgery, Trinity Centre for Health Sciences, Trinity College Dublin and St. James's Hospital, Dublin, Ireland.,Diabetes Complications Research Centre, Conway Institute for Biomedical Science, University College Dublin, Dublin, Ireland
| | - Neil G Docherty
- Diabetes Complications Research Centre, Conway Institute for Biomedical Science, University College Dublin, Dublin, Ireland
| | - Claire L Donohoe
- National Center for Esophageal and Gastric Cancer, Department of Surgery, Trinity Centre for Health Sciences, Trinity College Dublin and St. James's Hospital, Dublin, Ireland
| | - Narayanasamy Ravi
- National Center for Esophageal and Gastric Cancer, Department of Surgery, Trinity Centre for Health Sciences, Trinity College Dublin and St. James's Hospital, Dublin, Ireland
| | - Carel W le Roux
- Diabetes Complications Research Centre, Conway Institute for Biomedical Science, University College Dublin, Dublin, Ireland
| | - John V Reynolds
- National Center for Esophageal and Gastric Cancer, Department of Surgery, Trinity Centre for Health Sciences, Trinity College Dublin and St. James's Hospital, Dublin, Ireland
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Murphy CF, Stratford N, Docherty NG, Moran B, Elliott JA, Healy ML, McMorrow JP, Ravi N, Goldstone AP, Reynolds JV, le Roux CW. A Pilot Study of Gut-Brain Signaling After Octreotide Therapy for Unintentional Weight Loss After Esophagectomy. J Clin Endocrinol Metab 2021; 106:e204-e216. [PMID: 33000149 DOI: 10.1210/clinem/dgaa697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/24/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Recurrence-free patients after esophageal cancer surgery face long-term nutritional consequences, occurring in the context of an exaggerated postprandial gut hormone response. Acute gut hormone suppression influences brain reward signaling and eating behavior. This study aimed to suppress gut hormone secretion and characterize reward responses and eating behavior among postesophagectomy patients with unintentional weight loss. METHODS This pilot study prospectively studied postoperative patients with 10% or greater body weight loss (BWL) beyond 1 year who were candidates for clinical treatment with long-acting octreotide (LAR). Before and after 4 weeks of treatment, gut hormone secretion, food cue reactivity (functional magnetic resonance imaging), eating motivation (progressive ratio task), ad libitum food intake, body composition, and symptom burden were assessed. RESULTS Eight patients (7 male, age: mean ± SD 62.8 ± 9.4 years, postoperative BWL: 15.5 ± 5.8%) participated. Octreotide LAR did not significantly suppress total postprandial plasma glucagon-like peptide-1 response at 4 weeks (P = .08). Postprandial symptom burden improved after treatment (Sigstad score median [range]: 12 [2-28] vs 8 [3-18], P = .04) but weight remained stable (pre: 68.6 ± 12.8 kg vs post: 69.2 ± 13.4 kg, P = .13). There was no significant change in brain reward system responses, during evaluation of high-energy or low-energy food pictures, nor their appeal rating. Moreover, treatment did not alter motivation to eat (P = .41) nor ad libitum food intake(P = .46). CONCLUSION The protocol used made it feasible to characterize the gut-brain axis and eating behavior in this cohort. Inadequate suppression of gut hormone responses 4 weeks after octreotide LAR administration may explain the lack of gut-brain pathway alterations. A higher dose or shorter interdose interval may be required to optimize the intervention.
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Affiliation(s)
- Conor F Murphy
- Diabetes Complications Research Centre, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin 4, Ireland
- National Oesophageal and Gastric Centre, Trinity Centre for Health Sciences, Trinity College Dublin and St. James's Hospital, Dublin, Ireland
| | - Nicholas Stratford
- Diabetes Complications Research Centre, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin 4, Ireland
| | - Neil G Docherty
- Diabetes Complications Research Centre, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin 4, Ireland
| | - Brendan Moran
- Diabetes Complications Research Centre, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin 4, Ireland
| | - Jessie A Elliott
- Diabetes Complications Research Centre, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin 4, Ireland
- National Oesophageal and Gastric Centre, Trinity Centre for Health Sciences, Trinity College Dublin and St. James's Hospital, Dublin, Ireland
| | | | | | - Narayanasamy Ravi
- National Oesophageal and Gastric Centre, Trinity Centre for Health Sciences, Trinity College Dublin and St. James's Hospital, Dublin, Ireland
| | - Anthony P Goldstone
- PsychoNeuroEndocrinology Research Group, Centre for Neuropsychopharmacology, Division of Psychiatry, and Computational, Cognitive, and Clinical Neuroimaging Laboratory, Department of Brain Sciences, Faculty of Medicine, Imperial College London, Hammersmith Hospital, London, UK
| | - John V Reynolds
- National Oesophageal and Gastric Centre, Trinity Centre for Health Sciences, Trinity College Dublin and St. James's Hospital, Dublin, Ireland
| | - Carel W le Roux
- Diabetes Complications Research Centre, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin 4, Ireland
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Sjeltoft JR, Donsel PO, Vad H, Larsen MK, Missel M. A radical change: A qualitative study of patients' experiences of eating and daily living through the first year after oesophageal resection. Eur J Oncol Nurs 2020; 48:101800. [PMID: 32746000 DOI: 10.1016/j.ejon.2020.101800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/29/2020] [Accepted: 07/06/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE The purpose of this study is to explore the lived experiences of patients in terms of eating and consequences in everyday life in the first year after oesophageal cancer surgery. METHODS Thirteen patients participated in qualitative interviews one year after surgery for oesophageal cancer. Descriptions capturing the meaning of the lived experiences of patients were then derived from subsequent analysis and interpretation of the interviews. A phenomenological hermeneutical approach comprised the epistemological stance, and theoretical perspectives were drawn from Schutz' theory of everyday life. RESULTS Patient descriptions of their experiences with food, eating and everyday life in the first year after oesophageal cancer surgery fell into four themes: Adjusting to a different anatomy - food and eating as a dominant and difficult activity; changed body - food and eating as an underlying shadow; feeling different - social consequences of changed eating; a nutritional jungle - guidance and support in an uncertain time. CONCLUSION The physical and social consequences of oesophageal cancer resection upend everyday structures, requiring patients to adopt a new, conscious and reflexive approach to food and eating as a social activity. Continuous support from healthcare professionals and patient-to-patient interaction can help redefine everyday life.
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Affiliation(s)
| | - Pernille Orloff Donsel
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Henrik Vad
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Malene Kaas Larsen
- Department of Surgery, Odense University Hospital, Sdr. Boulevard, 5000, Odense, Denmark; Institute of Regional Health Research, University of Southern Denmark, Campusvej 55, 5000, Odense, Denmark.
| | - Malene Missel
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark.
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Larsen MK, Schultz H, Mortensen MB, Birkelund R. Patients' Experiences With Illness, Treatment, and Decision-Making for Esophageal Cancer: A Qualitative Study in a Danish Hospital Setting. Glob Qual Nurs Res 2020; 7:2333393620935098. [PMID: 32656299 PMCID: PMC7328478 DOI: 10.1177/2333393620935098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/22/2020] [Accepted: 05/26/2020] [Indexed: 12/12/2022] Open
Abstract
Patients with curable esophageal cancer or cancer in the esophageal
junction face several challenges during the course of their treatment
because of the burden of uncertainty in their prognoses and complexity
and side effects of the treatment. The aim of this study is to explore
patient experiences with illness, treatment, and decision-making in
the context of esophageal cancer. A qualitative approach using
phenomenological–hermeneutical methodology was used. Data consisted of
participant observations and interviews. We analyzed the data based on
Ricoeur’s theory of interpretation. The results show that patients
with esophageal cancer are putting their ordinary lives on hold and
experiencing the meal as a battleground during treatment. Patients
strive to maintain autonomy, gain control, and take ownership. The
results emphasize the need for a systematic approach to establish an
ongoing dialogue with patients throughout the course of treatment.
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Affiliation(s)
- Malene Kaas Larsen
- Odense University Hospital, Odense, Denmark.,University of Southern Denmark, Odense, Denmark
| | - Helen Schultz
- Odense University Hospital, Odense, Denmark.,University of Southern Denmark, Odense, Denmark
| | - Michael Bau Mortensen
- Odense University Hospital, Odense, Denmark.,University of Southern Denmark, Odense, Denmark
| | - Regner Birkelund
- University of Southern Denmark, Odense, Denmark.,Lillebaelt Hospital, Vejle, Denmark
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