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Kitagawa M, Uesugi Y. Factors affecting the duration required for meal intake among postgastrectomy patients. Clin Nutr ESPEN 2024; 60:303-308. [PMID: 38479926 DOI: 10.1016/j.clnesp.2024.02.011] [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: 04/11/2023] [Revised: 02/08/2024] [Accepted: 02/14/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND & AIMS Patients who had undergone gastrectomy often feel tired during meals as it takes longer for them to consume their meals, as compared to the length preoperatively. We aimed to clarify the factors affecting the duration required for food intake in this population. METHODS Participants enrolled in the study were patients who underwent total gastrectomy (TG) or distal gastrectomy (DG) within the past 5 years. We provided them with questionnaire using the mailing method. The following items were included in the questionnaire: demographics, treatment, total duration taken for three meals, meal contents, nutritional status, and Dysfunction After Upper Gastrointestinal Surgery 20 (DAUGS20) score. The participants were divided into the long duration group (LG) and short duration group (SG) of total meal duration. To compare the groups, a binomial logistic regression analysis was performed. RESULTS Among the 316 participants identified, those in the middle meal intake duration group and the outlier group of over 180 min were excluded. A total of 57 and 95 participants were enrolled in the LG (101-180 min, mean: 125.4 min [SD 16.1 min]) and SG (30-60 min, mean: 52.7 min [SD 8.9 min]), respectively. Age (odds ratio [OR]: 1.092; 95% confidence interval [CI]: 1.042; 1.145; p < 0.001), BMI (OR: 0.783; 95% CI: 0.675; 0.908; p = 0.001), and surgical type (TG/DG) (OR: 0.423; 95% CI: 0.190; 0.945; p = 0.036) were determined to be factors affecting the duration required for food intake. CONCLUSIONS The major factors for longer food intake duration were older age, lower BMI, and surgical type. Older people and individuals with a lower presurgery BMI were more likely to be included in the LG, which suggests that these factors could be associated with physical weakness, such as sarcopenia. Moreover, TG surgical type was more likely to cause a narrower gastrointestinal tract, especially in the area of anastomosis, which prolongs the food passage duration. For better QOL, postgastrectomy patients must be provided with knowledge on not only diet and nutrition but also efficient meal-taking, focusing on the physical decline associated with older age and lower BMI.
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Affiliation(s)
- Megumi Kitagawa
- Ehime Prefectural University of Health Science, Department of Nursing, Ehime, Japan.
| | - Yuko Uesugi
- Kinjyo Gakuin University, Department of Nursing, Aichi, Japan.
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2
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Schandl A, Färnqvist K, Mälberg K, Nielsen S, Lagergren P. Self-care advice for patients after surgery for oesophageal cancer - a mixed-methods systematic review. J Cancer Surviv 2024:10.1007/s11764-024-01551-0. [PMID: 38361104 DOI: 10.1007/s11764-024-01551-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 02/05/2024] [Indexed: 02/17/2024]
Abstract
PURPOSE The aim of the literature review was to identify and synthesise research on self-care advice for oesophageal cancer survivors. METHODS A mixed-methods systematic review and synthesis of existing literature on the topic. Five databases were searched for studies providing information on self-care advice for survivorship after oesophageal cancer surgery, in English, with no time filter. The Critical Appraisal Skills Program was used to assess the risk of bias. Data were presented by textual descriptions and grouping of data. RESULTS Among the 13 studies included in the review, five pieces of self-care advice were identified; reconstructing eating habits, bed-head elevation, health-promoting advice, monitoring symptoms and body functions, and involving family and friends. The self-care advice was experienced to be hard work, but worth the effort. They also provided reassurance and an increased understanding of bodily changes and social consequences of the disease and treatment. CONCLUSIONS There are is little evidence-based self-care advice for oesophageal cancer survivors. However, the existing self-care advice was appreciated and contributed to an increased understanding of the situation. Comprehensible and easy-to-follow recommendations should be provided to all oesophageal cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS Evidence-based self-care advice helpful for the individual oesophageal cancer survivor may be imperative to cope with the consequences of oesophagectomy after hospital discharge.
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Affiliation(s)
- Anna Schandl
- Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Retzius Väg 13A, 4th Floor, 17177, Stockholm, Sweden.
- Department of Anaesthesia and Intensive Care, Södersjukhuset, 11883, Stockholm, Sweden.
- Department of Clinical Science and Education, Karolinska Institutet Södersjukhuset, 11883, Stockholm, Sweden.
| | - Kenneth Färnqvist
- Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Retzius Väg 13A, 4th Floor, 17177, Stockholm, Sweden
| | - Kalle Mälberg
- Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Retzius Väg 13A, 4th Floor, 17177, Stockholm, Sweden
| | - Sandra Nielsen
- Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Retzius Väg 13A, 4th Floor, 17177, Stockholm, Sweden
| | - Pernilla Lagergren
- Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Retzius Väg 13A, 4th Floor, 17177, Stockholm, Sweden
- Department of Surgery and Cancer, Imperial College London, London, UK
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3
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Wang X, Liu X, Gu Z, Li X, Shu Y. Experiences and requirements in nutritional management of patients with esophageal cancer: a systematic review and qualitative meta-synthesis. Support Care Cancer 2023; 31:633. [PMID: 37843658 PMCID: PMC10579144 DOI: 10.1007/s00520-023-08100-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/02/2023] [Indexed: 10/17/2023]
Abstract
PURPOSE Nutritional management of patients with esophageal cancer is a significant issue. This systematic review aimed to comprehensively synthesize qualitative research evidence on the experiences and requirements in nutritional management from the perspective of patients with esophageal cancer. METHODS A systematic review and meta-synthesis of qualitative studies were conducted. Studies written in Chinese or English were retrieved from nine databases, namely, PubMed, Web of Science, Cochrane Library, CINAHL, Embase, CNKI, WanFang, VIP, and SinoMed, from inception to December 23, 2022. After screening the titles, abstracts, and full texts, 19 articles were finally included for quality assessment and meta-synthesis. RESULTS Three comprehensive themes were derived. These were dietary experiences (perception of symptoms and dietary behaviors), emotional experiences (negative and positive emotions), and social support (inappropriate social support and inadequate nutritional management). CONCLUSIONS The experiences and requirements of esophageal cancer patients in terms of nutritional management during treatment and rehabilitation were reviewed and factors influencing nutritional management were discussed. The findings suggested that medical institutions should expedite the development of comprehensive nutritional management systems, create conducive nutritional environmental facilities, and establish interdisciplinary teams to implement personalized comprehensive interventional models for the management of patient nutrition. These steps would maximize the effectiveness of nutritional therapy, promote early patient recovery, and bridge the gap between healthcare professionals and patients in the understanding of nutritional management.
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Affiliation(s)
- Xinwei Wang
- School of Nursing and Public Health, Yangzhou University, 136 Jiangyang Middle Road, Yangzhou, 225009, Jiangsu Province, China
| | - Xingyu Liu
- School of Nursing and Public Health, Yangzhou University, 136 Jiangyang Middle Road, Yangzhou, 225009, Jiangsu Province, China
| | - Zhie Gu
- Northern Jiangsu People's Hospital, 98 Nantong West Road, Yangzhou, 225001, Jiangsu Province, China
| | - Xiaojie Li
- School of Nursing and Public Health, Yangzhou University, 136 Jiangyang Middle Road, Yangzhou, 225009, Jiangsu Province, China
| | - Yusheng Shu
- Northern Jiangsu People's Hospital, 98 Nantong West Road, Yangzhou, 225001, Jiangsu Province, China.
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4
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Christodoulidis G, Kouliou MN, Koumarelas KE, Giakoustidis D, Athanasiou T. Quality of Life in Patients Undergoing Surgery for Upper GI Malignancies. Life (Basel) 2023; 13:1910. [PMID: 37763313 PMCID: PMC10532582 DOI: 10.3390/life13091910] [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: 08/03/2023] [Revised: 09/03/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
Upper gastrointestinal (GI) conditions vastly affect each individual's physical, social, and emotional status. The decision-making process by the medical personnel about these patients is currently based on a patient's life quality evaluation scale, HRQL scales. By utilizing HRQL scales, a better understanding of the various surgical and non-surgical treatment options, as well as their long-term consequences, can be achieved. In our study, an organ-based approach is used in an attempt to examine and characterized the effect of upper GI surgery on HRQL. Therefore, HRQL scales' function as a prognostic tool is useful, and the need for future research, the creation of valid training programs, and modern guidelines is highlighted.
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Affiliation(s)
- Grigorios Christodoulidis
- Department of General Surgery, University Hospital of Larissa, University of Thessaly, Biopolis, 41110 Larissa, Greece; (M.-N.K.); (K.-E.K.)
| | - Marina-Nektaria Kouliou
- Department of General Surgery, University Hospital of Larissa, University of Thessaly, Biopolis, 41110 Larissa, Greece; (M.-N.K.); (K.-E.K.)
| | - Konstantinos-Eleftherios Koumarelas
- Department of General Surgery, University Hospital of Larissa, University of Thessaly, Biopolis, 41110 Larissa, Greece; (M.-N.K.); (K.-E.K.)
| | - Dimitris Giakoustidis
- Department of Surgery, General Hospital Papageorgiou, Aristotle University of Thessaloniki, 56429 Thessaloniki, Greece;
| | - Thanos Athanasiou
- Department of Cardiothoracic Surgery, University Hospital of Larissa, University of Thessaly, Biopolis, 41110 Larissa, Greece;
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Raubinger S, Allworth S, Carey S. When you are living and dying at the same time: A qualitative exploration of living with gastrointestinal motility disorders. J Hum Nutr Diet 2022; 36:622-631. [PMID: 36420640 DOI: 10.1111/jhn.13114] [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: 08/09/2022] [Accepted: 10/25/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND An expanding base of evidence indicates that chronic gastrointestinal disorders not only impact physical wellbeing, but also affect many psychosocial aspects of life. However, less is known about gastrointestinal motility disorders. The present study aimed to explore how individuals experience gastrointestinal motility disorders and their impact on daily living. METHODS Eleven people with a gastrointestinal motility disorder participated in semi-structured interviews face-to-face or via telephone. The interviews explored how participants came to be diagnosed, their experiences with health professionals, as well as the impact of dysmotility on enjoyment of food, socialising, eating out and quality of life (QoL). Interviews were tape-recorded, transcribed and analysed using an inductive thematic analysis approach. RESULTS Analysis revealed an overarching theme of frustration that stemmed from three subthemes: (1) feeling misunderstood, judged and dismissed by health professionals leading to delayed diagnosis, misdiagnosis and multiple diagnoses; (2) severity and unpredictability of undesirable gastrointestinal symptoms; and (3) reduced QoL because of physical and social limitations, impairing their ability to have normal life experiences, including education, work and social activities. CONCLUSIONS Dysmotility is a complex illness that impacts almost all aspects of a person's life. In addition to managing reported physical symptoms, the social and psychological burden associated with dysmotility needs to be addressed to improve outcomes and QoL.
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Affiliation(s)
- Sian Raubinger
- Department of Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Sarah Allworth
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Sharon Carey
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Department of Nutrition and Dietetics, Royal Prince Alfred Hospital, Sydney, Australia.,Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
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Dunne RF, Roeland EJ. The Interplay Among Pancreatic Cancer, Cachexia, Body Composition, and Diabetes. Hematol Oncol Clin North Am 2022; 36:897-910. [PMID: 36154783 DOI: 10.1016/j.hoc.2022.07.001] [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: 11/18/2022]
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is associated with complex changes in body composition. Visceral obesity and type 2 diabetes mellitus are established risk factors for developing PDAC; however, clinical and metabolic features of PDAC commonly lead to cancer cachexia, a hypermetabolic syndrome characterized by weight loss secondary to muscle and adipose tissue wasting. Reduction in muscle mass in patients with PDAC is associated with poorer survival in patients undergoing surgical resection and increased chemotherapy toxicity. Although no standardized treatment exists, a multidisciplinary, tailored, symptom-based approach is recommended to improve outcomes and quality of life for patients with PDAC and cachexia.
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Affiliation(s)
- Richard F Dunne
- Department of Medicine, Wilmot Cancer Institute, University of Rochester Medical Center, 601 Elmwood Avenue, Box 704, Rochester, NY 14642, USA.
| | - Eric J Roeland
- Division of Hematology/Oncology, Oregon Health and Science University, Knight Cancer Institute, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
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Yeung S, Gill M, Gillis C. Nutrition education: Optimising preparation and recovery for benign oesophageal surgery. J Hum Nutr Diet 2022. [PMID: 35821616 DOI: 10.1111/jhn.13064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 06/10/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Patients requiring upper gastrointestinal surgery for benign oesophageal conditions are at nutrition risk before and after surgery. There is a dearth of published evidence guiding clinicians on effective collaboration with patients to mitigate perioperative nutritional challenges. We conducted a qualitative study aiming to explore patients' perioperative food, nutrition, and educational experiences to guide future care. METHODS Adult patients who had undergone elective, benign oesophageal surgery were invited to participate in semi-structured interviews within 3 weeks of hospital discharge. Interviews were transcribed and analysed with a reflexive form of inductive thematic analysis in addition to synthesised member checking. RESULTS Interviews with 12 patients identified three major themes. First, nutrition education fosters a better surgical recovery experience: patients expressed a desire to be prepared for their upcoming surgery and engage in the recovery process with informed food choices. Most patients preferred preoperative education given limited capacity for learning during hospital admission. Second, patients have priorities for nutrition information: patients expressed that educational material should be printed, comprehensive, practical, include familiar foods and focus on managing postoperative physical symptoms. Third, food impacts social and emotional experiences of surgery: resumption of a normal diet was a sign of recovery that enabled social reintegration. Identified themes resonated with Knowles' six-core principles of andragogy. CONCLUSIONS Patients with benign oesophageal conditions perceived nutrition education to be a vital aspect of surgical preparation and recovery. Re-designing perioperative education with patient input has the potential to improve outcomes and experiences.
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Affiliation(s)
- Sophia Yeung
- Nutrition Services, Alberta Health Services, Calgary, AB, Canada
| | - Marlyn Gill
- Patient and Community Engagement Research, University of Calgary, Calgary, AB, Canada
| | - Chelsia Gillis
- School of Human Nutrition, McGill University, Montreal, QC, Canada
- Department of Anesthesia, McGill University, Montreal, QC, Canada
- Department of Surgery, McGill University, Montreal, QC, Canada
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8
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Rowsell A, Sodergren SC, Vassiliou V, Darlington AS, Guren MG, Alkhaffaf B, Moorbey C, Dennis K, Terada M. Systematic review of health-related quality of life (HRQoL) issues associated with gastric cancer: capturing cross-cultural differences. Gastric Cancer 2022; 25:665-677. [PMID: 35689705 PMCID: PMC9225973 DOI: 10.1007/s10120-022-01309-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 05/16/2022] [Indexed: 02/07/2023]
Abstract
The treatment landscape for gastric cancer (GC) is constantly evolving with therapies affecting all aspects of health-related quality of life (HRQoL) which need careful monitoring. While there are HRQoL measures designed specifically to capture issues relevant to patients with GC, these might be outdated and only relevant to patients in westernised cultures. This review identifies the patient-reported measures used to assess HRQoL of patients with GC and compares the HRQoL measures used across cultures including East Asia, where GC is more prevalent. We conducted a systematic review of publications between January 2001 and January 2021. A total of 267 papers were identified; the majority (66%) of studies involved patients from East Asian countries. Out of the 24 HRQoL questionnaires captured, the European Organisation for Research and Treatment of Cancer Core Cancer measure (QLQ-C30) was the most widely used (60% of all studies and 62% of those involving patients from East Asian countries), followed by its gastric cancer-specific module (QLQ-STO22, 34% of all studies and 41% from East Asia). Eight questionnaires were developed within East Asian countries and, of the 20 studies including bespoke questions, 16 were from East Asia. There were six qualitative studies. HRQoL issues captured include diarrhoea, constipation, reflux, abdominal pain and abdominal fulness or bloating, difficulty swallowing, restricted eating, and weight loss. Psychosocial issues related to these problems were also assessed. Issues relating to the compatibility of some of the westernised measures within East Asian cultures were highlighted.
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Affiliation(s)
- Alison Rowsell
- School of Health Sciences, University of Southampton, Highfield, Southampton, SO17 1BJ, UK
| | - Samantha C Sodergren
- School of Health Sciences, University of Southampton, Highfield, Southampton, SO17 1BJ, UK.
| | | | - Anne-Sophie Darlington
- School of Health Sciences, University of Southampton, Highfield, Southampton, SO17 1BJ, UK
| | - Marianne G Guren
- Department of Oncology, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Bilal Alkhaffaf
- Department of Oesophago-Gastric & Bariatric Surgery, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, School of Medical Sciences, University of Manchester, Manchester, UK
| | - Chantelle Moorbey
- School of Health Sciences, University of Southampton, Highfield, Southampton, SO17 1BJ, UK
| | - Kristopher Dennis
- Division of Radiation Oncology, The Ottawa Hospital Cancer Centre, Ottawa, K1H 8L6, Canada
- Department of Radiology, University of Ottawa, Ottawa, K1N 6N5, Canada
| | - Mitsumi Terada
- Asian Partnerships Office, Department of International Clinical Development/International Trials Management Section, Clinical Research Support Office, National Cancer Center Hospital, Tokyo, Japan
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Deftereos I, Yeung JM, Arslan J, Carter VM, Isenring E, Kiss N. Health service nutrition practices and associations with clinical outcomes in patients undergoing resection for upper gastrointestinal cancer: results from the multi-centre NOURISH point prevalence study. J Hum Nutr Diet 2022; 36:468-478. [PMID: 35320596 DOI: 10.1111/jhn.13006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 03/05/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study aimed to investigate health service nutrition practices of sites providing care to patients undergoing surgery for upper gastrointestinal (UGI) cancer within Australia, including the provision of perioperative nutrition support services and outpatient clinics, and the use of evidence-based nutrition care pathways/protocols. Secondary aims were to investigate associations between the use of a nutrition care pathway/protocol and patient outcomes. METHODS Principal investigator dietitians for the sites (n=27) participating in the NOURISH point prevalence study participated in a purpose-built site-specific survey regarding perioperative nutrition practices and protocols. Data from the 200 patients who participated in the study (including malnutrition prevalence, preoperative weight loss and receipt of dietetics intervention, intraoperative feeding tube insertions, provision of nutrition support day one post surgery, length of stay and complications) were investigated using multivariate analysis to determine associations with the sites' use of a nutrition care pathway/protocol. RESULTS The majority of sites (>92%) reported having dietetics services available in chemotherapy/radiotherapy. Eighty-five percent of sites reported having some form of outpatient clinic service; however, a routine service was only available at 26% of sites preoperatively and 37% postoperatively. Most preoperative services were embedded into surgical/oncology clinics (70%); however, this was reported for only 44% of postoperative clinics. Only 44% had a nutrition care pathway/protocol in place. The use of a nutrition care pathway/protocol was associated with lower rates of malnutrition, and higher rates of preoperative dietetics intervention, intraoperative feeding tube insertions and ESPEN guideline compliant care day one post surgery. CONCLUSIONS The results of this study demonstrate varied perioperative outpatient nutrition services in this high-risk patient group. The use of nutrition care pathways and protocols was associated with improved patient outcomes. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Irene Deftereos
- Department of Surgery, Western Precinct, Melbourne Medical School, The University of Melbourne, St Albans, VIC 3021, Australia.,Department of Nutrition and Dietetics, Western Health, Footscray, VIC 3011, Australia
| | - Justin Mc Yeung
- Department of Surgery, Western Precinct, Melbourne Medical School, The University of Melbourne, St Albans, VIC 3021, Australia.,Department of Colorectal Surgery, Western Health, Footscray, VIC 3011, Australia.,Western Health Chronic Disease Alliance, Western Health, Footscray, VIC 3011, Australia
| | - Janan Arslan
- Department of Surgery, Western Precinct, Melbourne Medical School, The University of Melbourne, St Albans, VIC 3021, Australia
| | - Vanessa M Carter
- Department of Nutrition and Dietetics, Western Health, Footscray, VIC 3011, Australia
| | - Elizabeth Isenring
- Faculty of Health Sciences and Medicine, Bond University, Robina, QLD 4226, Australia.,Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, QLD 4102
| | - Nicole Kiss
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC 3220, Australia.,Allied Health Research, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
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Deftereos I, Yeung JMC, Arslan J, Carter VM, Isenring E, Kiss N, Cardamis A, Dorey A, Ottaway A, Maguire B, Cleeve B, Davis C, Zoanetti C, Gray C, Choong C, Douglas C, Nixon C, Platt D, Quinn E, Simpson E, Hamdorf E, McNamara E, Whelan E, Jegendran G, Moore G, Lockwood G, McNamara J, Corrigan J, Haaksma K, Fox K, Furness K, Cochrane KW, Huynh K, Lee KC, Hames N, Hendricks N, Page N, Brooks N, Nevin L, Parfrey L, Putrus E, Pons R, Hoevenaars R, Singh S, McCoy S, Wallin S, Mexias S, Daniells S, Storr T, Robertson T, Brown T. Adherence to ESPEN guidelines and associations with postoperative outcomes in upper gastrointestinal cancer resection: results from the multi-centre NOURISH point prevalence study. Clin Nutr ESPEN 2022; 47:391-398. [DOI: 10.1016/j.clnesp.2021.10.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 10/25/2021] [Indexed: 12/23/2022]
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11
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Perceptions of Experiences of Recovery After Pancreaticoduodenectomy—A Phenomenographic Interview Study. Cancer Nurs 2022; 45:172-180. [DOI: 10.1097/ncc.0000000000001021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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12
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Johnston EA, van der Pols JC, Ekberg S. Needs, preferences, and experiences of adult cancer survivors in accessing dietary information post-treatment: A scoping review. Eur J Cancer Care (Engl) 2020; 30:e13381. [PMID: 33377564 DOI: 10.1111/ecc.13381] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/13/2020] [Accepted: 11/18/2020] [Indexed: 01/08/2023]
Abstract
INTRODUCTION To support provision of healthy lifestyle information tailored to patients' needs and preferences, this review maps adult cancer survivors' self-reported needs, preferences, and experiences accessing dietary information post-treatment. METHODS A scoping review of research published within the past decade conducted using PRISMA-ScR guidelines. Seven databases were searched in June 2020. RESULTS Of 15,973 articles identified, 57 met eligibility criteria. Studies most frequently included survivors of breast cancer (49%), persons aged 40+ years (95%), ≤5 years post-diagnosis (54%), and residing in North America (44%). Cancer survivors commonly identified needing information regarding healthy eating, particularly practical skills, and support in changing dietary behaviours. Preferences included specific recommendations, direct communication with healthcare professionals, and peer support from other cancer survivors. In practice, survivors frequently reported receiving generic advice from healthcare professionals, limited dietary follow-up, and lack of referral to support. Unmet needs in healthcare settings led to dietary information-seeking elsewhere; however, survivors indicated difficulty identifying credible sources. Personal beliefs and desire for involvement in care motivated dietary information-seeking post-treatment. CONCLUSION Cancer survivors' experiences accessing dietary information post-treatment do not align with needs and preferences. Less is known about survivors who are young adults, >5 years post-diagnosis, and living in rural areas.
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Affiliation(s)
- Elizabeth A Johnston
- School of Exercise and Nutrition Sciences, Queensland University of Technology (QUT), Kelvin Grove, QLD, Australia
| | - Jolieke C van der Pols
- School of Exercise and Nutrition Sciences, Queensland University of Technology (QUT), Kelvin Grove, QLD, Australia
| | - Stuart Ekberg
- School of Psychology and Counselling, Queensland University of Technology (QUT), Kelvin Grove, QLD, Australia
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Larsen MK, Birkelund R, Mortensen MB, Schultz H. Undertaking responsibility and a new role as a relative: a qualitative focus group interview study. Scand J Caring Sci 2020; 35:952-961. [PMID: 33089551 DOI: 10.1111/scs.12916] [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: 05/19/2020] [Revised: 08/27/2020] [Accepted: 09/21/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Being a relative of a patient with oesophageal cancer can evoke strong emotions and uncertainty about the future. As a consequence of the treatment course for oesophageal cancer and an increase in outpatient treatment, relatives are becoming increasingly responsible for patients' physical and emotional care. There is a lack of research exploring relatives' experiences with illness, treatment and decision-making. AIMS AND OBJECTIVES To explore relatives' experiences with illness, treatment of the patient and decision-making in the context of oesophageal cancer. DESIGN A qualitative explorative design was chosen. METHODS We conducted two focus group interviews with 11 relatives. The analysis was based on Ricoeur's theory of interpretation. RESULTS Throughout illness and treatment, relatives faced the fear of loss, leading to distress and anxiety. Relatives were simultaneously taking responsibility and asserting a new role during treatment as they regarded treatment as a joint affair. Regarding decision-making, relatives positioned themselves on the sidelines, awaiting the authority of the patients and healthcare professionals to give them space for participation. CONCLUSION Relatives of patients with oesophageal cancer undergoing treatment are suppressing their anxiety and doubt about the future. As they are undertaking responsibility during treatment, they are claiming control in new areas, which leads to changing roles within the family. However, they do not feel empowered in decision-making because they recognise patients' decision-making authority. This study highlights the complexity of balancing patients' authority with acknowledgement of relatives' role as active collaborators.
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Affiliation(s)
- Malene Kaas Larsen
- Department of Surgery, Odense University Hospital, Odense C, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense M, Denmark
| | - Regner Birkelund
- Lillebaelt Hospital - University Hospital of Southern Denmark & Institute of Regional Health Research, Vejle, Denmark.,University of Southern Denmark, Odense M, Denmark
| | - Michael Bau Mortensen
- Department of Surgery, Odense University Hospital, Odense C, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense M, Denmark
| | - Helen Schultz
- Department of Surgery, Odense University Hospital, Odense C, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense M, 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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15
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Gustavell T, Sundberg K, Langius-Eklöf A. Using an Interactive App for Symptom Reporting and Management Following Pancreatic Cancer Surgery to Facilitate Person-Centered Care: Descriptive Study. JMIR Mhealth Uhealth 2020; 8:e17855. [PMID: 32554375 PMCID: PMC7330738 DOI: 10.2196/17855] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 03/10/2020] [Accepted: 03/12/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Pancreatic and periampullary cancers are rare but have high mortality rates. The only hope for cure is surgical removal of the tumor. Following pancreatic surgery, the patients have a great deal of responsibility for managing their symptoms. Patients report a lack of sufficient knowledge of self-care and unmet supportive care needs. This necessitates a health care system responsive to these needs and health care professionals who pay close attention to symptoms. Person-centered care is widely encouraged and means a shift from a model in which the patient is the passive object of care to a model involving the patient as an active participant in their own care. To address the challenges in care following pancreatic cancer surgery, an interactive app (Interaktor) was developed in which patients regularly report symptoms and receive support for self-care. The app has been shown to reduce patients' symptom burden and to increase their self-care activity levels following pancreaticoduodenectomy due to cancer. OBJECTIVE The aim of the study was to describe how patients used the Interaktor app following pancreaticoduodenectomy due to cancer and their experience with doing so. METHODS A total of 115 patients were invited to use Interaktor for 6 months following pancreaticoduodenectomy. Of those, 35 declined, 8 dropped out, and 46 did not meet the inclusion criteria after surgery, leaving 26 patients for inclusion in the analysis. The patients were instructed to report symptoms daily through the app for up to 6 months following surgery. In case of alerting symptoms, they were contacted by their nurse. Data on reported symptoms, alerts, and viewed self-care advice were logged and analyzed with descriptive statistics. Also, the patients were interviewed about their experiences, and the data were analyzed using thematic analysis. RESULTS The patients' median adherence to symptom reporting was 82%. Fatigue and pain were the most reported symptoms. Alerting symptoms were reported by 24 patients, and the most common alert was fever. There were variations in how many times the patients viewed the self-care advice (range 3-181 times). The most commonly viewed advice concerned pancreatic enzyme supplements. Through the interviews, the overarching theme was "Being seen as a person," with the following 3 sub-themes: "Getting your voice heard," "Having access to an extended arm of health care," and "Learning about own health." CONCLUSIONS Interaktor proved to be well accepted. It made patients feel reassured at home and offered support for self-care. The app facilitated person-centered care by its multiple features targeting individual supportive care needs and enabled participation in their own care. This supports our recent studies showing that patients using the app had less symptom burden and higher self-care activity levels than patients receiving only standard care.
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Affiliation(s)
- Tina Gustavell
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Nursing, Stockholm, Sweden.,Karolinska University Hospital, Theme Cancer, Department of Upper Abdominal Diseases, Stockholm, Sweden
| | - Kay Sundberg
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Nursing, Stockholm, Sweden
| | - Ann Langius-Eklöf
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Nursing, Stockholm, Sweden
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16
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Ren JY, Zhong JD, Yuan J, Zhang JE, Li CZ, Wei WJ. Unmet supportive care needs and associated factors among Chinese discharged patients with esophageal cancer after esophagectomy: A cross-sectional study. Eur J Oncol Nurs 2020; 46:101767. [PMID: 32504878 DOI: 10.1016/j.ejon.2020.101767] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 05/05/2020] [Accepted: 05/06/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE After esophagectomy, patients experience a series of problems that severely affect their quality of life. Understanding their unmet needs could help medical staff provide better supportive care. The aim of this study was to investigate the supportive care needs of discharged patients with esophageal cancer after esophagectomy and explore the factors associated with these needs. METHOD A total of 167 discharged patients with esophageal cancer after esophagectomy were recruited from a University Cancer Center in China and investigated using a self-designed demographic and clinical characteristics questionnaire, the 34-item Supportive Care Needs Survey, and the M.D. Anderson Symptom Inventory Gastrointestinal Cancer Module. RESULTS Approximately 95.2% of the patients had ≥1 unmet need(s). The overall level of supportive care needs of patients after esophagectomy was mild to medium. Most of the top 10 moderate-to-severe unmet needs were identified in the health and information domains. Age (β = -0.157, p = 0.011), dysphagia (β = -0.178, p = 0.005), recurrence (β = 0.175, p = 0.005), time since diagnosis (β = -0.150, p = 0.018), and symptom interference (β = 0.488, p < 0.001) were significantly associated with supportive care needs. CONCLUSIONS Discharged patients with esophageal cancer after esophagectomy had a wide range of unmet supportive care needs. It is essential to combine the associated factors to accurately evaluate patient needs. We should pay more attention to propose comprehensive measures for these patients and provide more individualized supportive care during the lengthy recovery period.
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Affiliation(s)
- Jin Ying Ren
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Jiu Di Zhong
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Juan Yuan
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jun E Zhang
- School of Nursing, Sun Yat-sen University, Guangzhou, China.
| | - Chuan Zhen Li
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Wei Jin Wei
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
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17
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Development and Feasibility of an Interactive Smartphone App for Early Assessment and Management of Symptoms Following Pancreaticoduodenectomy. Cancer Nurs 2020; 42:E1-E10. [PMID: 29596113 DOI: 10.1097/ncc.0000000000000584] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Patients who have undergone pancreaticoduodenectomy because of pancreatic cancer experience distressing symptoms and unmet supportive care needs after discharge. To meet these needs, we have developed a mobile health app (Interaktor) for daily assessment of symptoms and access to self-care advice that includes a risk assessment model for alerts with real-time interactions with professionals. OBJECTIVE The study aim was to develop and test a version of the Interaktor app adapted for patients who have undergone pancreaticoduodenectomy. METHODS The app was developed and tested for feasibility in 6 patients during 4 weeks. One nurse monitored and responded to alerts. Logged data from the app were collected, and all participants were interviewed about their experiences. RESULTS Adherence to reporting daily was 84%. Alerts were generated in 41% of the reports. The patients felt reassured and cared for and received support for symptom management. The app was easy to use, had relevant content, and had few technical problems, although suggestions for improvement were given. CONCLUSIONS The daily reporting of symptoms and having access to a nurse in real time in the case of an alarming symptom seem to enhance symptom management and render a feeling of security in patients. Some modifications of the app are needed before use in a larger sample. IMPLICATIONS FOR PRACTICE Daily reporting of symptoms after pancreaticoduodenectomy enhances symptom management, self-care, and participation without being a burden to patients, indicating that mobile health can be used in clinical practice by patients with poor prognosis who experience severe symptoms.
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18
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Abstract
Germline CDH1 mutation carriers are at risk for early-onset diffuse gastric cancer (DGC) and female carriers have an additional risk of lobular breast cancer. The reported literature GC risk of 70% has led to the recommendation for germline mutation carriers to undergo prophylactic total gastrectomy (PTG). The objective of this research was to examine post-surgical clinical outcomes and to identify which of the domains/symptoms from the European Organisation for Research and Treatment of Cancer QOL Questionnaire (EORTC QLQ-C30) were determinants of overall quality of life (QOL) in individuals undergoing PTG. Participants were recruited through multiple sources. Postsurgical clinical outcomes were obtained from hospital records. Participants completed validated questionnaires measuring generic and condition specific QOL (PROMIS, EORTC and SF 36v.II) at a single point in time. The mean QOL in this cohort was 70.6 (SD = 25.6), which is better than reference values from the general populations in USA and Canada Role and social function plus the symptoms anxiety, pain, taste, dyspnea and diarrhea were significant predictor variables for QOL (p < 0.05). Although this study reveals good overall QOL for individuals after PTG, attention should be given to managing symptoms as part of long term care to further enhance QOL. The function/symptom scores were associated with worse overall health and global health status and thus may mark a real need for more attentive post-surgical care.
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19
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Hellstadius Y, Malmström M, Lagergren P, Sundbom M, Wikman A. Reflecting a crisis reaction: Narratives from patients with oesophageal cancer about the first 6 months after diagnosis and surgery. Nurs Open 2019; 6:1471-1480. [PMID: 31660175 PMCID: PMC6805708 DOI: 10.1002/nop2.348] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 07/04/2019] [Accepted: 07/05/2019] [Indexed: 12/16/2022] Open
Abstract
AIM The aim of the study was to describe patients' experiences of emotional adaption following treatment for oesophageal cancer from diagnosis to 6 months after surgery. DESIGN A qualitative interview study using an inductive approach was carried out. METHODS Participants were recruited from two university hospitals in Sweden. Ten patients who had been operated for oesophageal cancer with curative intent 6 months earlier and consented to participate in the study were included. Patients who had a disease recurrence were not eligible for inclusion. Participants were interviewed with a semi-structured interview approach. Data were analysed using qualitative content analysis. RESULTS One overarching theme was identified; Experiencing a crisis reaction, which comprised three key categories; (a) From emotionally numb to feeling quite alright; (b) From a focus on cure to reflections about a whole new life; and (c) From a severe treatment to suffering an emaciated, non-compliant body, derived from 14 distinct sub-categories. CONCLUSION This study highlights the process of emotional adaptation following oesophageal cancer surgery that patients describe when reflecting back on the first 6 months postoperatively pointing to a crisis reaction in this early postoperative period.
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Affiliation(s)
| | - Marlene Malmström
- Department of Clinical SciencesSkåne University Hospital, Lund UniversityLundSweden
| | - Pernilla Lagergren
- Department of Molecular Medicine and SurgeryKarolinska InstituteStockholmSweden
| | - Magnus Sundbom
- Department of Surgical SciencesUppsala UniversityUppsalaSweden
| | - Anna Wikman
- Department of Women's and Children's HealthUppsala UniversityUppsalaSweden
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20
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Gustavell T, Sundberg K, Segersvärd R, Wengström Y, Langius-Eklöf A. Decreased symptom burden following surgery due to support from an interactive app for symptom management for patients with pancreatic and periampullary cancer. Acta Oncol 2019; 58:1307-1314. [PMID: 31284797 DOI: 10.1080/0284186x.2019.1633473] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background: Patients with pancreatic and periampullary cancer have poor prognoses, experience multiple symptoms following surgery and sometimes lack knowledge of self-care activities. Consequently, it is vital to develop systems that support self-management, improvement of health-related quality of life and reduction of symptoms. Therefore, the aim was to evaluate the impact on health-related quality of life and self-care activity when using the Interaktor app following pancreaticoduodenectomy due to cancer. Material and Methods: Patients in the intervention group used Interaktor up to six months after surgery. They reported symptoms daily at home and received support for self-management by continuous access to written self-care advice and to their healthcare professionals. Descriptive data from the app were collected. Health-related quality of life and self-care activity were collected before surgery, and six weeks and six months after surgery. Comparisons between the intervention group (n = 26) and a historical control group (n = 33) were made. Decline/dropout rate was 37% in the intervention group and 10% in the control group. Results: Six weeks after surgery the intervention group rated significantly higher emotional functioning and less nausea/vomiting, pain, appetite loss, constipation, pancreatic pain, flatulence and worry about low weight. Twenty-five subscales/items showed non-statistical differences. Six months after surgery the intervention group rated significantly fewer hepatic symptoms, less worry about low weight, and higher self-care activity level. Thirty subscales/items showed non-statistical differences. The first four weeks, patients reported symptoms in a median 95% of the intended days, and for the rest of the period in median 83%. Conclusion: The use of an app for management of patient-reported outcomes reduces symptom burdens six weeks after pancreaticoduodenectomy due to cancer. Interaktor is well accepted for patients choosing to participate and appears to facilitate supportive care needs and timely symptom management for this patient group. Future studies should also include cost-benefits and objective measures.
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Affiliation(s)
- Tina Gustavell
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
- Department of Upper Abdominal Diseases, Cancer Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Kay Sundberg
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
| | - Ralf Segersvärd
- Department of Upper Abdominal Diseases, Cancer Theme, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Science, Intervention and Technology, Division of Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Yvonne Wengström
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
- Cancer Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Ann Langius-Eklöf
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
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21
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Pinto E, Cavallin F, Scarpa M. Psychological support of esophageal cancer patient? J Thorac Dis 2019; 11:S654-S662. [PMID: 31080642 PMCID: PMC6503274 DOI: 10.21037/jtd.2019.02.34] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 02/04/2019] [Indexed: 12/22/2022]
Abstract
Important questions are still open about psychological aspects in esophageal cancer (EC) and about the related psychological support. How to cope with the cancer diagnosis and poor prognosis: a psychological counselling may be a valid option to personalize the communication to patients with a poor prognosis. How to cope with long chemoradiotherapy: after neoadjuvant therapy, patients know that curative process is not completed, and they perceive the severity of the neoadjuvant side effects, considering themselves "fragile" and far from a healthy condition before the major surgery they are going to undergo. Therefore, this is a particularly crucial point when psychological support may be useful. How to cope with change of nutritional habits: esophagectomy for cancer strongly impairs nutritional function in the early postoperative period and feeding Jejunostomy impairs emotional function. How to cope with sleep disturbances: most cancer patients report disturbed sleep after cancer diagnosis and/or following cancer treatment. Psychological intervention aims to identify underlying concerns worsening sleep quality. How to cope with postoperative complications: the occurrence of such complications reduces patient's satisfaction and has a negative effect on doctor-patient relationship. How to cope with long-term functions impairment: EC patients need a plan for the future.
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Affiliation(s)
- Eleonora Pinto
- Esophageal and Digestive Tract Surgical Unit, Regional Centre for Esophageal Disease, Veneto Institute of Oncology (IOV-IRCCS), Padova, Italy
| | | | - Marco Scarpa
- General Surgery Unit, Azienda Ospedaliera di Padova, Padova, Italy
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22
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Elliott JA, Docherty NG, Murphy CF, Eckhardt HG, Doyle SL, Guinan EM, Ravi N, Reynolds JV, le Roux CW. Changes in gut hormones, glycaemic response and symptoms after oesophagectomy. Br J Surg 2019; 106:735-746. [PMID: 30883706 DOI: 10.1002/bjs.11118] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 11/21/2018] [Accepted: 12/13/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Oesophagectomy is associated with reduced appetite, weight loss and postprandial hypoglycaemia, the pathophysiological basis of which remains largely unexplored. This study aimed to investigate changes in enteroendocrine function after oesophagectomy. METHODS In this prospective study, 12 consecutive patients undergoing oesophagectomy were studied before and 10 days, 6, 12 and 52 weeks after surgery. Serial plasma total fasting ghrelin, and glucagon-like peptide 1 (GLP-1), insulin and glucose release following a standard 400-kcal mixed-meal stimulus were determined. CT body composition and anthropometry were assessed, and symptom scores calculated using European Organisation for Research and Treatment of Cancer (EORTC) questionnaires. RESULTS At 1 year, two of the 12 patients exhibited postprandial hypoglycaemia, with reductions in bodyweight (mean(s.e.m.) 17·1(3·2) per cent, P < 0·001), fat mass (21.5(2.5) kg versus 25.5(2.4) kg before surgery; P = 0·014), lean body mass (51.5(2.2) versus 54.0(1.8) kg respectively; P = 0·003) and insulin resistance (HOMA-IR: 0.84(0.17) versus 1.16(0.20); P = 0·022). Mean(s.e.m.) fasting ghrelin levels decreased from postoperative day 10, but had recovered by 1 year (preoperative: 621·5(71·7) pg/ml; 10 days: 415·1(59·80) pg/ml; 6 weeks: 309·0(42·0) pg/ml; 12 weeks: 415·8(52·1) pg/ml; 52 weeks: 547·4(83·2) pg/ml; P < 0·001) and did not predict weight loss (P = 0·198). Postprandial insulin increased progressively at 10 days, 6, 12 and 52 weeks (mean(s.e.m.) insulin AUC0-30 min : fold change 1·7(0·4), 2·0(0·4), 3·5(0·7) and 4·0(0·8) respectively; P = 0·001). Postprandial GLP-1 concentration increased from day 10 after surgery (P < 0·001), with a 3·3(1·8)-fold increase at 1 year (P < 0·001). Peak GLP-1 level was inversely associated with the postprandial glucose nadir (P = 0·041) and symptomatic neuroglycopenia (Sigstad score, P = 0·017, R2 = 0·45). GLP-1 AUC predicted loss of weight (P = 0·008, R2 = 0·52) and fat mass (P = 0·010, R2 = 0·64) at 1 year. CONCLUSION Altered enteroendocrine physiology is associated with early satiety, weight loss and postprandial hypoglycaemia after oesophagectomy.
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Affiliation(s)
- J A Elliott
- Diabetes Complications Research Centre, Conway Institute of Biomedical and Biomolecular Research, University College Dublin, Dublin, Ireland.,National Oesophageal and Gastric Centre, Trinity Centre for Health Sciences, Trinity College Dublin and St James's Hospital, Dublin, Ireland
| | - N G Docherty
- Diabetes Complications Research Centre, Conway Institute of Biomedical and Biomolecular Research, University College Dublin, Dublin, Ireland.,Department of Gastrosurgical Research and Education, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - C F Murphy
- Diabetes Complications Research Centre, Conway Institute of Biomedical and Biomolecular Research, University College Dublin, Dublin, Ireland.,National Oesophageal and Gastric Centre, Trinity Centre for Health Sciences, Trinity College Dublin and St James's Hospital, Dublin, Ireland
| | - H-G Eckhardt
- Diabetes Complications Research Centre, Conway Institute of Biomedical and Biomolecular Research, University College Dublin, Dublin, Ireland
| | - S L Doyle
- School of Biological Sciences, Dublin Institute of Technology, Dublin, Ireland
| | - E M Guinan
- National Oesophageal and Gastric Centre, Trinity Centre for Health Sciences, Trinity College Dublin and St James's Hospital, Dublin, Ireland
| | - N Ravi
- National Oesophageal and Gastric Centre, Trinity Centre for Health Sciences, Trinity College Dublin and St James's Hospital, Dublin, Ireland
| | - J V Reynolds
- National Oesophageal and Gastric Centre, Trinity Centre for Health Sciences, Trinity College Dublin and St James's Hospital, Dublin, Ireland
| | - C W le Roux
- Diabetes Complications Research Centre, Conway Institute of Biomedical and Biomolecular Research, University College Dublin, Dublin, Ireland.,Department of Gastrosurgical Research and Education, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
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23
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Missel M, Hansen M, Jackson R, Siemsen M, Schønau MN. Re-embodying eating after surgery for oesophageal cancer: Patients' lived experiences of participating in an education and counselling nutritional intervention. J Clin Nurs 2018; 27:1420-1430. [PMID: 29399901 DOI: 10.1111/jocn.14297] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2018] [Indexed: 12/20/2022]
Abstract
AIMS AND OBJECTIVES To provide in-depth insight into patients' lived experiences of participating in an education and counselling nutritional intervention after curative surgery for oesophageal cancer. BACKGROUND Surgery for oesophageal cancer carries a risk of malnutrition. The consequences of nutritional problems may lead to increased morbidity and mortality postoperatively and have consequences for convalescence, rehabilitation and quality of life. DESIGN Qualitative study based on a phenomenological approach. The theoretical framework was grounded in the philosophy of Merleau-Ponty. METHODS Qualitative interviews were conducted with 10 patients who participated in an education and counselling nutritional intervention after surgery for oesophageal squamous-cell carcinoma. Data were analysed according to the principles of Kvale and Brinkmann, and their three levels of interpretation were applied. FINDINGS The essence of experiencing the education and counselling nutritional intervention can be divided into three themes: embodied disorientation, living with increased attention to bodily functions and re-embodying eating. CONCLUSIONS Patients were living with increased attention to bodily functions and tried to find a balance between the task of eating and nutritional needs. Despite the embodied perceptions of alterations after oesophageal cancer surgery, the patients developed high levels of bodily awareness and skills in self-management. This process was characterised by reconnecting to the body and re-embodying eating. The intervention empowered the patients to regain some control of their own bodies in an effort to regain agency in their own lives. RELEVANCE TO CLINICAL PRACTICE There is a need for systematic long-term follow-up after surgery for oesophageal cancer regarding nutrition. The findings of this study can inform future supportive nutrition care service development aimed at supporting patients to learn to eat sufficiently after oesophageal resection.
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Affiliation(s)
- Malene Missel
- Department of Cardiothoracic Surgery, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Rie Jackson
- Department of Anaesthesiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Mette Siemsen
- Department of Cardiothoracic Surgery, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Mai Nanna Schønau
- Department of Cardiothoracic Surgery, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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24
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Pancreatic enzyme replacement therapy following surgery for pancreatic cancer: An exploration of patient self-management. Clin Nutr ESPEN 2018; 26:97-103. [PMID: 29908691 DOI: 10.1016/j.clnesp.2018.04.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 04/09/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND For those diagnosed with pancreatic cancer, ill-addressed pancreatic exocrine insufficiency (PEI) following surgery can result in malnutrition related complications that may impact on predict mortality and morbidity. The use of pancreatic enzyme replacement therapy (PERT) is recommended and often demands a degree of patient self-management. Understanding more about how this treatment is managed is fundamental to optimising care. OBJECTIVE This study aimed to explore patient self-management of PERT following surgery for pancreatic cancer. METHODS Semi-structured interviews were conducted with nine participants. Eligible participants included adult patients who had undergone surgery for a malignancy in the pancreatic region and were prescribed PERT post-operatively. Inductive thematic analysis was used to analyse our findings. RESULTS Data analysis revealed three overarching themes; the role of professional support, factors influencing decisions to use PERT in symptom management and the challenges of socializing. The difficulties negotiated by participants were considerable as they struggled with the complexities of PERT. Symptom management and subsequently reported physical repercussions and undesirable social implications were problematic. Professional support was largely inconsistent and relinquished prematurely following discharge. Consequently, this impacted on how PERT was self-managed. CONCLUSION Enabling patients to appropriately self-manage PERT may lessen the post-treatment burden. Our findings suggest that support should continue throughout the recovery phase and should address the patient's 'self-management journey'. Intervention by healthcare professionals, such as a specialist dietitian is likely to be beneficial. Furthermore there are focal issues, primarily explicit education and appropriately timed information that require consideration by those developing and delivering services.
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25
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Svetanoff WJ, McGahan R, Singhal S, Bertellotti C, Mittal SK. Quality of life after esophageal resection. PATIENT-RELATED OUTCOME MEASURES 2018; 9:137-146. [PMID: 29670413 PMCID: PMC5894654 DOI: 10.2147/prom.s150180] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Introduction Esophageal resection is the primary treatment for malignant esophageal disease and the last resort for benign end-stage esophageal disease. There is a paucity of research comparing the long-term quality of life (QoL) following surgery among these two populations. The aim of this study was to examine the patient reported QoL after esophageal resection using questionnaires focusing on general well-being and esophageal-specific symptoms. Methods A prospectively maintained database of post-operatively administered European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTC QLQ-C30) with supplemental esophageal cancer-specific questionnaires (OES-18) was queried after institutional review board approval through Creighton University School of Medicine. Inclusions were made if patients received an esophageal resection for benign or malignant esophageal disease. Emergency procedures, delayed reconstructions, and stage IV disease were excluded. Student’s t-test was used for domains of function, symptoms, QoL, and esophageal-specific complaints to compare the groups with each other and with the general population. Results A total of 39 out of 248 patients with malignant disease and 24 out of 46 with benign disease completed the questionnaire. A mean post-operative follow-up of 53 months with a response rate of 40% was obtained. There was no difference in physical (p=0.81), role (p =0.37), conditional (p=0.73), emotional (p=0.06), or social functions (p=0.42) between the general population and the esophageal resection groups. There was also no significant difference in generalized pain (p=0.86), nausea/vomiting (p=0.27), fatigue (p=0.86), swallowing (p=0.35), or esophageal pain (p=0.12). The malignant cohort had better outcomes than the benign cohort with respect to eating (p=0.04), indigestion (p=0.04), and QoL (p=<0.01). Discussion The underlying disease between these cohorts is drastically different, but postoperative functional status, generalized symptoms, swallowing ability, and esophageal pain were similar. There was no difference in functional status between the general population and the esophageal resection cohorts. Patients with malignant disease reported less problems with eating and a better QoL than their benign counterparts.
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Affiliation(s)
- Wendy Jo Svetanoff
- Department of Pediatric Surgery, Boston Children's Hospital, Boston, MA, USA.,Department of Surgery, Creighton University School of Medicine, Omaha, NE, USA
| | - Rose McGahan
- Department of Surgery, Creighton University School of Medicine, Omaha, NE, USA
| | - Saurabh Singhal
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Carrie Bertellotti
- Department of Surgery, Creighton University School of Medicine, Omaha, NE, USA
| | - Sumeet K Mittal
- Department of Surgery, Creighton University School of Medicine, Omaha, NE, USA.,Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
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Alberda C, Alvadj-Korenic T, Mayan M, Gramlich L. Nutrition Care in Patients With Head and Neck or Esophageal Cancer: The Patient Perspective. Nutr Clin Pract 2017; 32:664-674. [DOI: 10.1177/0884533617725050] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
| | - Tatjana Alvadj-Korenic
- Women’s and Children’s Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Maria Mayan
- Women’s and Children’s Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Leah Gramlich
- Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada
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Hallowell N, Lawton J, Badger S, Richardson S, Hardwick RH, Caldas C, Fitzgerald RC. The Psychosocial Impact of Undergoing Prophylactic Total Gastrectomy (PTG) to Manage the Risk of Hereditary Diffuse Gastric Cancer (HDGC). J Genet Couns 2017; 26:752-762. [PMID: 27837291 DOI: 10.1007/s10897-016-0045-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 10/26/2016] [Indexed: 12/13/2022]
Abstract
Individuals identified as at high risk of developing Hereditary Diffuse Gastric Cancer (HDGC) are advised to undergo prophylactic surgery - have their stomach removed - in their early twenties. Research with (older) cancer patients who undergo gastrectomy for curative reasons suggests that gastric resection has a number of physical and psychosocial sequelae. Because it is difficult to extrapolate the findings of studies of older cancer patients to younger healthy patients who are considering prophylactic total gastrectomy (PTG), the aim of this qualitative interview study was to determine the psychosocial implications of undergoing prophylactic surgery to manage genetic risk. Fourteen men and 13 women from the UK's Familial Gastric Cancer study who had undergone PTG were invited to participate in qualitative interviews. Most reported that undergoing surgery and convalescence was easier than anticipated. There was evidence that age affected experiences of PTG, with younger patients tending to report faster recovery times and more transient aftereffects. All saw the benefits of risk reduction as outweighing the costs of surgery. Surgery was described as having a range of physical impacts (disrupted appetite, weight loss, fatigue, GI symptoms) that had related psychological, social and economic implications. Those considering PTG need to be aware that its impact on quality of life is difficult to predict and negative sequelae may be ongoing for some individuals.
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Affiliation(s)
- Nina Hallowell
- Ethox Centre, Nuffield Department of Population Health, University of Oxford, Old Road, Oxford, OX3 7LF, UK.
| | - Julia Lawton
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Shirlene Badger
- PHG Foundation, Cambridge, UK
- Institute of Public Health, University of Cambridge, Cambridge, UK
| | | | - Richard H Hardwick
- Cambridge University Hospitals Trust, Addenbrookes Hospital, Cambridge, UK
| | - Carlos Caldas
- Cambridge University Hospitals Trust, Addenbrookes Hospital, Cambridge, UK
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - Rebecca C Fitzgerald
- Cambridge University Hospitals Trust, Addenbrookes Hospital, Cambridge, UK
- MRC Cancer Unit, University of Cambridge, Cambridge, UK
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Hallowell N, Badger S, Richardson S, Caldas C, Hardwick RH, Fitzgerald RC, Lawton J. An investigation of the factors effecting high-risk individuals' decision-making about prophylactic total gastrectomy and surveillance for hereditary diffuse gastric cancer (HDGC). Fam Cancer 2016; 15:665-76. [PMID: 27256430 PMCID: PMC5935221 DOI: 10.1007/s10689-016-9910-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Hereditary diffuse gastric cancer has an early onset and poor prognosis, therefore, individuals who carry a pathogenic (CDH1) mutation in the E-cadherin gene (CDH1) are offered endoscopic surveillance and advised to undergo prophylactic total gastrectomy (PTG) in their early to mid-twenties. Patients not ready or fit to undergo gastrectomy, or in whom the genetic testing result is unknown or ambiguous, are offered surveillance. Little is known about the factors that influence decisions to undergo or decline PTG, making it difficult to provide optimal support for those facing these decisions. Qualitative interviews were carried out with 35 high-risk individuals from the Familial Gastric Cancer Study in the UK. Twenty-seven had previously undergone PTG and eight had been identified as carrying a pathogenic CDH1 mutation but had declined surgery at the time of interview. The interviews explored the experience of decision-making and factors influencing risk-management decisions. The data suggest that decisions to proceed with PTG are influenced by a number of potentially competing factors: objective risk confirmation by genetic testing and/or receiving a positive biopsy; perceived familial cancer burden and associated risk perceptions; perceptions of post-surgical life; an increasing inability to tolerate endoscopic procedures; a concern that surveillance could miss a cancer developing and individual's life stage. These findings have implications for advising this patient group.
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Affiliation(s)
- Nina Hallowell
- Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | - Shirlene Badger
- PHG Foundation and Institute of Public Health, University of Cambridge, Cambridge, UK
| | | | - Carlos Caldas
- Cambridge University Hospitals Trust, Addenbrookes Hospital, Cambridge, UK
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - Richard H Hardwick
- Cambridge University Hospitals Trust, Addenbrookes Hospital, Cambridge, UK
| | - Rebecca C Fitzgerald
- Cambridge University Hospitals Trust, Addenbrookes Hospital, Cambridge, UK
- MRC Cancer Unit, University of Cambridge, Cambridge, UK
| | - Julia Lawton
- Centre for Population Health Sciences, University of Edinburgh, Cambridge, UK
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30
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de Vries YC, Helmich E, Karsten MDA, Boesveldt S, Winkels RM, van Laarhoven HWM. The impact of chemosensory and food-related changes in patients with advanced oesophagogastric cancer treated with capecitabine and oxaliplatin: a qualitative study. Support Care Cancer 2016; 24:3119-26. [PMID: 26919988 PMCID: PMC4877431 DOI: 10.1007/s00520-016-3128-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 02/09/2016] [Indexed: 01/19/2023]
Abstract
Purpose Chemosensory changes are frequently observed side effects of cytotoxic treatment and have an impact on daily life by altering food-related behaviour and daily practices. For oesophagogastric cancer patients, these changes can be particularly important as they may have specific needs with regard to eating, due to obstruction of the upper intestinal tract. The purpose of this study was to gain insight into the impact of chemosensory and food-related changes in oesophagogastric cancer patients undergoing chemotherapy and how this may influence the practical and social aspects of food-related behaviour of patients and their relatives. Methods We used a qualitative interview approach with a cross-sectional design using semi-structured interviews. Template analysis was used to analyse patients’ experiences with and the impact of chemosensory changes on daily life. Thirteen advanced oesophagogastric cancer patients treated with capecitabine and oxaliplatin were included by convenience sampling, recruited from one academic hospital, and interviewed at home or in the hospital. Results There was a large variation in the impact of chemosensory changes in oesophagogastric cancer (OGC) patients, though daily life was impacted substantially when chemosensory and/or food-related changes were experienced. Three main themes emerged from the interviews: altered food preferences, practical constraints in daily life, and impact on social functioning. Conclusion Chemosensory and food-related changes significantly influenced food preferences and had practical and social consequences in daily life of patients and their relatives. Specific nutritional care for these patients should be directed towards enhancing food enjoyment and should take the specific needs, related to the location of the tumour, into account.
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Affiliation(s)
- Yfke C de Vries
- Top Institute Food and Nutrition, P.O. Box 557, Wageningen, 6700 AN, The Netherlands. .,Division of Human Nutrition, Wageningen University, P.O. Box 8129, 6700 EV, Wageningen, The Netherlands.
| | - Esther Helmich
- Center for Evidence-Based Education, Academic Medical Center, Amsterdam, The Netherlands.,Rehabilitation and Care Center Vreugdehof, Amsterdam, The Netherlands
| | - Matty D A Karsten
- Division of Human Nutrition, Wageningen University, P.O. Box 8129, 6700 EV, Wageningen, The Netherlands
| | - Sanne Boesveldt
- Division of Human Nutrition, Wageningen University, P.O. Box 8129, 6700 EV, Wageningen, The Netherlands
| | - Renate M Winkels
- Division of Human Nutrition, Wageningen University, P.O. Box 8129, 6700 EV, Wageningen, The Netherlands
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Jiang LQ. Effects of centralized preoperative interview in patients with gastrointestinal operation. Shijie Huaren Xiaohua Zazhi 2015; 23:1855-1860. [DOI: 10.11569/wcjd.v23.i11.1855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the effects of preoperative interview in patients with gastrointestinal operation.
METHODS: One hundred and sixty patients undergoing gastrointestinal operation at People's Hospital of Dongyang City were divided into an observation group and a control groups according to the way of preoperative interview, with 80 cases in each group. The control group received conventional preoperative interview, and the observation group received centralized preoperative interview. The rate of interview, total interview time, anxiety and depression status, complications, and postoperative satisfaction were compared for the two groups.
RESULTS: The rate of interview in the observation group was significantly higher than that in the control group (t = 20.949, P = 0.000), but the total interview time was significantly shorter than the control group (t = 26.881, P = 0.000). Before the intervention, anxiety and depression scores had no statistical differences between the two groups; after intervention, anxiety and depression scores were significantly decreased in both groups, and the decrease was more significant in the observation group (t = 9.438, P = 0.000; t = 8.641, P = 0.000). The numbers of cases of postoperative nausea (t = 21.055, P = 0.000), sore throat (t = 25.004, P = 0.000) and wound infection (t = 5.129, P = 0.024) in the observation group were significantly lower centralized than in the control group. The number of patients who were very satisfied (t = 20.783, P = 0.000) and the total satisfaction (t = 12.471, P = 0.000) were significantly higher in the observation group than in the control group.
CONCLUSION: Centralized preoperative interview can effectively improve the interview rate, shorten the total interview time, improve anxiety and depression, reduce postoperative complications, and improve the patient's satisfaction.
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Cooper C, Burden ST, Molassiotis A. An explorative study of the views and experiences of food and weight loss in patients with operable pancreatic cancer perioperatively and following surgical intervention. Support Care Cancer 2015; 23:1025-33. [PMID: 25277960 DOI: 10.1007/s00520-014-2455-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 09/21/2014] [Indexed: 12/31/2022]
Abstract
PURPOSE Malnutrition and weight loss are highly prevalent in patients with pancreatic cancer. However, little is known about how patients experience such changes after completion of a surgery. The aim of this study was to explore the views and experiences about weight loss and food in patients with operable pancreatic cancer perioperatively and following surgical treatment. METHODS An exploratory study underpinned by hermeneutic phenomenological philosophy was conducted. Thirteen post-surgery patients with pancreatic cancer were recruited from a National Health Service (NHS) Trust in the north of England. Sampling was purposive and data were collected using semi-structured in-depth interviews. Each interview was digitally recorded, transcribed verbatim and analysed using NVivo 8. RESULTS Six themes emerged from the data that represented the patients' views and experience of foods and weight loss after surgery: "struggling with weight loss", "being pressured to eat", "experiences with nutrition support therapy", "perception of the role of the dietitians", "lacking appropriate dietary instructions" and "road to recovery". CONCLUSIONS The study has found that sufficient dietary advice, appropriate nutrition support and patient self-management are significant factors that affect how people recover from surgery for pancreatic cancer. Further work is required to understand the nature and effect of weight loss in surgical patients with pancreatic cancer and the role of food in their weight management.
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Affiliation(s)
- C Cooper
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
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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.
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Lee HO, Han SR, Choi SI, Lee JJ, Kim SH, Ahn HS, Lim H. Effects of intensive nutrition education on nutritional status and quality of life among postgastrectomy patients. Ann Surg Treat Res 2015; 90:79-88. [PMID: 26878015 PMCID: PMC4751149 DOI: 10.4174/astr.2016.90.2.79] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 10/15/2015] [Accepted: 10/19/2015] [Indexed: 12/04/2022] Open
Abstract
Purpose We examined the effects of 3 months of intensive education (IE) after hospital discharge compared to conventional education (CE) on nutritional status and quality of diet and life among South Korean gastrectomy patients. Methods The study was conducted among 53 hospitalized gastrectomy in-patients (IE group, n = 28; CE group, n = 25) at Kyung Hee University Hospital at Gangdong. Baseline data were collected from electronic medical records and additional information was gathered via anthropometric measurements, assessment of nutritional status through a patient-generated, subjective global assessment (PG-SGA), diet assessment, and measures of self-efficacy and satisfaction with meals for 3 months following hospital discharge. Results Total PG-SGA scores were significantly higher in the CE group than in the IE group at 3-week post-discharge (5.2 in the IE group vs. 10.4 in the CE group, P < 0.001), with higher scores indicating a greater severity of malnutrition. Energy intake over the 3 months increased in both the IE group (from 1,390 to 1,726 kcal/day) and the CE group (from 1,227 to 1,540 kcal/day). At 3-week post-discharge, the IE group had significantly higher daily protein and fat intake (P < 0.05). Self-efficacy improved in each category (P < 0.001), except for 'difficulty eating adequate food'. When assessing satisfaction with meals, there was a difference in the 'satisfaction with the current meal size' (P < 0.001) and 'satisfaction with the menu content' (P < 0.001). Conclusion Nutritional status among gastrectomy patients in the IE group improved. Relative to the CE control, the IE group demonstrated improved self-efficacy and meal satisfaction 3-week post-discharge.
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Affiliation(s)
- Hye Ok Lee
- Nutrition Team, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - So Ra Han
- Department of Food and Nutrition, Sungshin Women's University, Seoul, Korea
| | - Sung Il Choi
- Department of Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Jung Joo Lee
- Nutrition Team, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Sang Hyun Kim
- Department of Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Hong Seok Ahn
- Department of Food and Nutrition, Sungshin Women's University, Seoul, Korea
| | - Hyunjung Lim
- Department of Medical Nutrition, Graduate School of East-West Medical Science, Kyung Hee University, Yongin, Korea.; Institute of Medical Nutrition, Kyung Hee University, Seoul, Korea
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Barker LA, Crowe TC. Nutritional management of gastrointestinal surgical patients in Victoria's public hospitals. Nutr Diet 2014. [DOI: 10.1111/1747-0080.12145] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Lisa A. Barker
- Nutrition and Dietetics; Monash Health; Clayton Victoria Australia
- School of Exercise and Nutrition Sciences; Deakin University; Burwood Victoria Australia
| | - Timothy C. Crowe
- Nutrition and Dietetics; Monash Health; Clayton Victoria Australia
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