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Miao Y, Nie X, He WW, Luo CY, Xia Y, Zhou AR, Wei SR, Wang CH, Fang Q, Peng L, Leng XF, Han YT, Luo L, Xie Q. Longitudinal patient-reported outcomes after minimally invasive McKeown esophagectomy for patients with esophageal squamous cell carcinoma. Support Care Cancer 2024; 32:237. [PMID: 38509239 PMCID: PMC10954946 DOI: 10.1007/s00520-024-08428-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 03/08/2024] [Indexed: 03/22/2024]
Abstract
PURPOSE Surgery for esophageal squamous cell carcinoma (ESCC) is characterized by a poor prognosis and high complication rate, resulting in a heavy symptom burden and poor health-related quality of life (QOL). We evaluated longitudinal patient-reported outcomes (PROs) to analyze the correlations between symptoms and QOL and their changing characteristics during postoperative rehabilitation. METHODS We investigated patients with ESCC who underwent minimally invasive McKeown esophagectomy at Sichuan Cancer Hospital between April 2019 and December 2019. Longitudinal data of the clinical characteristics and PROs were collected. The MD Anderson Symptom Inventory and European Organization for Research and Treatment of Cancer (EORTC) QOL questionnaires were used to assess symptoms and QOL and compare the trajectories of PROs during the investigation. RESULTS A total of 244 patients with ESCC were enrolled in this study. Regarding QOL, role and emotional functions returned to baseline at 1 month after surgery, and cognitive and social functions returned to baseline at 3 months after surgery. However, physical function and global QOL did not return to baseline at 1 year after surgery. At 7 days and 1, 3, 6, and 12 months after surgery, the main symptoms of the patients were negatively correlated with physical, role, emotional, cognitive, and social functions and the overall health status (P < 0.05). CONCLUSION Patients with ESCC experience reduced health-related QOL and persisting symptoms after minimally invasive McKeown esophagectomy, but a recovery trend was observed within 1 month. The long-term QOL after esophagectomy is acceptable.
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Affiliation(s)
- Yan Miao
- Department of Thoracic Surgery, Sichuan Cancer Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, Sichuan, 610041, People's Republic of China
| | - Xin Nie
- Department of Thoracic Surgery, Sichuan Cancer Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, Sichuan, 610041, People's Republic of China
| | - Wen-Wu He
- Department of Thoracic Surgery, Sichuan Cancer Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, Sichuan, 610041, People's Republic of China
| | - Chun-Yan Luo
- Department of Thoracic Surgery, Sichuan Cancer Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, Sichuan, 610041, People's Republic of China
| | - Yan Xia
- Department of Thoracic Surgery, Sichuan Cancer Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, Sichuan, 610041, People's Republic of China
| | - Ao-Ru Zhou
- Department of Thoracic Surgery, Sichuan Cancer Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, Sichuan, 610041, People's Republic of China
| | - Si-Rui Wei
- Department of Thoracic Surgery, Sichuan Cancer Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, Sichuan, 610041, People's Republic of China
| | - Cheng-Hao Wang
- Department of Thoracic Surgery, Sichuan Cancer Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, Sichuan, 610041, People's Republic of China
| | - Qiang Fang
- Department of Thoracic Surgery, Sichuan Cancer Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, Sichuan, 610041, People's Republic of China
| | - Lin Peng
- Department of Thoracic Surgery, Sichuan Cancer Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, Sichuan, 610041, People's Republic of China
| | - Xue-Feng Leng
- Department of Thoracic Surgery, Sichuan Cancer Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, Sichuan, 610041, People's Republic of China
| | - Yong-Tao Han
- Department of Thoracic Surgery, Sichuan Cancer Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, Sichuan, 610041, People's Republic of China
| | - Lei Luo
- Department of Thoracic Surgery, Sichuan Cancer Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, Sichuan, 610041, People's Republic of China.
| | - Qin Xie
- Department of Thoracic Surgery, Sichuan Cancer Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, Sichuan, 610041, People's Republic of China.
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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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Wang YJ, He XD, He YQ, Bao T, Xie XF, Li KK, Guo W. Comparison of two different methods for lymphadenectomy along the left recurrent laryngeal nerve by minimally invasive esophagectomy in patients with esophageal squamous cell carcinoma: a prospective randomized trial. Int J Surg 2024; 110:159-166. [PMID: 37737902 PMCID: PMC10793764 DOI: 10.1097/js9.0000000000000788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/10/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Lymph nodes along the left recurrent laryngeal nerve (LRLN) is thought to be highly involved in esophageal cancer. Given the unique anatomical positioning of the nerve, performing lymphadenectomy in this region requires advanced techniques within limited working space. Meanwhile, high incidence of morbidity and mortality is associated with lymphadenectomy. Although several methods have been applied to reduce the technical requirement and the incidence of postoperative complication, the optimal method remains controversial. METHODS This study was a single-center, prospective, randomized trial to investigate the utility of lymphadenectomy along the LRLN during the minimally invasive esophagectomy in esophageal squamous cell carcinoma patients by comparing the surgical outcome, postoperative complication, survival rate, and quality of life (QoL) between the retraction method (RM) and the suspension method (SM) in patients with esophageal cancer from June 2018 to November 2020. QoL was assessed according to questionnaire: EQ-5D-5L. RESULTS Of 94 patients were enrolled and randomized allocated to RM and SM group equally. Characteristics did not differ between groups. The duration of lymph node dissection along LRLN was significant longer in SM group ( P <0.001). No difference was observed about postoperative complications. One of in-hospital death was occurred in each group ( P >0.999). Patients in neither of groups exhibiting difference about 3-year disease-free survival rate ( P =0.180) and overall survival rate ( P =0.430). No difference was observed in postoperative QoL between groups at different time points (all, P >0.05). CONCLUSION Both methods of lymph node dissection along the LRLN during minimally invasive esophagectomy in esophageal squamous cell carcinoma patients are technically feasible and safe. The RM appears more favorable in terms of reducing surgical duration compared to the SM.
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Affiliation(s)
- Ying-Jian Wang
- Department of Thoracic Surgery, Army Medical Center of PLA (Daping Hospital), Daping
| | - Xian-Dong He
- Department of Thoracic Surgery, Army Medical Center of PLA (Daping Hospital), Daping
| | - Yi-Qiu He
- Department of Pediatrics, Shapingba District Maternity and Infant Health Hospital, Shapingba, Choingqing, People’s Republic of China
| | - Tao Bao
- Department of Thoracic Surgery, Army Medical Center of PLA (Daping Hospital), Daping
| | - Xian-Feng Xie
- Department of Thoracic Surgery, Army Medical Center of PLA (Daping Hospital), Daping
| | - Kun-Kun Li
- Department of Thoracic Surgery, Army Medical Center of PLA (Daping Hospital), Daping
| | - Wei Guo
- Department of Thoracic Surgery, Army Medical Center of PLA (Daping Hospital), Daping
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Acharya R, Mahapatra A, Verma HK, Bhaskar LVKS. Unveiling Therapeutic Targets for Esophageal Cancer: A Comprehensive Review. Curr Oncol 2023; 30:9542-9568. [PMID: 37999111 PMCID: PMC10670555 DOI: 10.3390/curroncol30110691] [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: 09/12/2023] [Revised: 10/19/2023] [Accepted: 10/27/2023] [Indexed: 11/25/2023] Open
Abstract
Esophageal cancer is a highly aggressive and deadly disease, ranking as the sixth leading cause of cancer-related deaths worldwide. Despite advances in treatment, the prognosis remains poor. A multidisciplinary approach is crucial for achieving complete remission, with treatment options varying based on disease stage. Surgical intervention and endoscopic treatment are used for localized cancer, while systemic treatments like chemoradiotherapy and targeted drug therapy play a crucial role. Molecular markers such as HER2 and EGFR can be targeted with drugs like trastuzumab and cetuximab, and immunotherapy drugs like pembrolizumab and nivolumab show promise by targeting immune checkpoint proteins. Epigenetic modifications offer new avenues for targeted therapy. Treatment selection depends on factors like stage, tumor location, and patient health, with post-operative and rehabilitation care being essential. Early diagnosis, appropriate treatment, and supportive care are key to improving outcomes. Continued research is needed to develop effective targeted drugs with minimal side effects. This review serves as a valuable resource for clinicians and researchers dedicated to enhancing esophageal cancer treatment outcomes.
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Affiliation(s)
- Rakesh Acharya
- Department of Zoology, Guru Ghasidas Vishwavidyalaya, Bilaspur 495009, India; (R.A.); (A.M.)
| | - Ananya Mahapatra
- Department of Zoology, Guru Ghasidas Vishwavidyalaya, Bilaspur 495009, India; (R.A.); (A.M.)
| | - Henu Kumar Verma
- Department of Immunopathology, Institute of lungs Health and Immunity, Comprehensive Pneumology Center, Helmholtz Zentrum, Neuherberg, 85764 Munich, Germany;
| | - L. V. K. S. Bhaskar
- Department of Zoology, Guru Ghasidas Vishwavidyalaya, Bilaspur 495009, India; (R.A.); (A.M.)
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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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Verdonck-de Leeuw I, Dawson C, Licitra L, Eriksen JG, Hosal S, Singer S, Laverty DP, Golusinski W, Machczynski P, Varges Gomes A, Girvalaki C, Simon C, Leemans CR. European Head and Neck Society recommendations for head and neck cancer survivorship care. Oral Oncol 2022; 133:106047. [PMID: 35932637 DOI: 10.1016/j.oraloncology.2022.106047] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 07/22/2022] [Indexed: 11/18/2022]
Abstract
Survivors of head and neck cancer can experience long-term consequences of the cancer and subsequent treatments even after the cancer has resolved. Increasingly clinicians are aware of the social, psychological, financial, and emotional impacts of these cancers, in addition to the support required for the physical symptoms. This review provides recommendations on the long-term management and support required for survivors of head and neck cancer in the European healthcare setting.
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Affiliation(s)
- Irma Verdonck-de Leeuw
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department Otolaryngology-Head and Neck Surgery, De Boelelaan 1117, Amsterdam, the Netherlands; Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, the Netherlands; Vrije Universiteit Amsterdam, Department Clinical, Neuro and Developmental Psychology, Van der Boechorststraat 7-9, Amsterdam, the Netherlands; Amsterdam Public Health, Mental Health, Amsterdam, the Netherlands.
| | - Camilla Dawson
- Speech and Language Therapist-Dysphagia and Altered Airways University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
| | - Lisa Licitra
- Head and Neck Cancer Medical Oncology Unit and Head & Neck Research Program at the Istituto Nazionale Tumori in Milan, Italy.
| | - Jesper Grau Eriksen
- Experimental Clinical Oncology, Aarhus University Hospital, Entrance C, Level 1, C108, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus, Denmark.
| | - Sefik Hosal
- Department of Otolaryngology-Head & Neck Surgery, Atılım University Faculty of Medicine, Ankara, Turkey.
| | - Susanne Singer
- Institute of Medical Biostatistics, Epidemiology, and Informatics, University Hospital of Johannes Gutenberg University Mainz, Germany.
| | - Dominic P Laverty
- Restorative Dentistry, Birmingham Dental Hospital, 5 Mill Pool Way, Birmingham B5 7EG, UK.
| | - Wojciech Golusinski
- Department of Head and Neck Surgery Poznan University of Medical Sciences, The Greater Poland Cancer Centre, 15 Garbary St., 61-866 Poznan, Poland.
| | - Piotr Machczynski
- Department of Head and Neck Surgery Poznan University of Medical Sciences, The Greater Poland Cancer Centre, 15 Garbary St., 61-866 Poznan, Poland.
| | - Ana Varges Gomes
- Centro Hospitalar e Universitario do Algarve, Chair of Administration Council, MD Medical Oncologist, Portugal.
| | - Charis Girvalaki
- European Cancer Patient Coalition, Avenue des Arts 6, 1210 Brussels, Belgium.
| | - Christian Simon
- Chef-de-service, Service d'Oto-rhino-laryngologie et chirurgie cervico-faciale CHUV, UNIL, Rue du Bugnon 46, 1011 Lausanne, Switzerland.
| | - C René Leemans
- Department of Otolaryngology - Head and Neck Surgery, Cancer Center Amsterdam, Amsterdam UMC - Vumc, P.O. Box 7057, 1007MB Amsterdam, the Netherlands.
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Chen TT, Yan HJ, He X, Fu SY, Zhang SX, Yang W, Zuo YJ, Tang HT, Yang JJ, Liu PZ, Wen HY, Tian D. A novel web-based dynamic nomogram for recurrent laryngeal nerve lymph node metastasis in esophageal squamous cell carcinoma. Front Surg 2022; 9:898705. [PMID: 36081588 PMCID: PMC9445191 DOI: 10.3389/fsurg.2022.898705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 07/13/2022] [Indexed: 11/18/2022] Open
Abstract
Background Patients with esophageal squamous cell carcinoma (ESCC) are liable to develop recurrent laryngeal nerve (RLN) lymph node metastasis (LNM). We aimed to assess the predictive value of the long diameter (LD) and short diameter (SD) of RLN lymph node (LN) and construct a web-based dynamic nomogram for RLN LNM prediction. Methods We reviewed 186 ESCC patients who underwent RLN LN dissection from January 2016 to December 2018 in the Affiliated Hospital of North Sichuan Medical College. Risk factors for left and right RLN LNM were determined by univariate and multivariate analyses. A web-based dynamic nomogram was constructed by using logistic regression. The performance was assessed by the area under the curve (AUC) and Brier score. Models were internally validated by performing five-fold cross-validation. Results Patients who underwent left and right RLN LN dissection were categorized as left cohort (n = 132) and right cohort (n = 159), with RLN LNM rates of 15.9% (21/132) and 21.4% (34/159), respectively. The AUCs of the LD (SD) of RLN LN were 0.663 (0.688) in the left cohort and 0.696 (0.705) in the right cohort. The multivariate analysis showed that age, the SD of RLN LN, and clinical T stage were significant risk factors for left RLN LNM (all P < 0.05), while tumor location, the SD of RLN LN, and clinical T stage were significant risk factors for right RLN LNM (all P < 0.05). The dynamic nomograms showed reliable performance after five-fold cross-validation [(left (right), mean AUC: 0.814, range: 0.614–0.891 (0.775, range: 0.084–0.126); mean Brier score: 0.103, range: 0.084–0.126 (0.145, range: 0.105–0.206)], available at https://mpthtw.shinyapps.io/leftnomo/ and https://mpthtw.shinyapps.io/rightnomo/. Conclusion The LD and SD of RLN LN are inadequate to predict RLN LNM accurately, but online dynamic nomograms by combined risk factors show better prediction performance and convenient clinical application.
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Affiliation(s)
- Ting-Ting Chen
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
- Department of Cardiothoracic Intensive Care Unit, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
- College of Medical Imaging, North Sichuan Medical College, Nanchong, China
| | - Hao-Ji Yan
- College of Medical Imaging, North Sichuan Medical College, Nanchong, China
| | - Xi He
- Department of Radiological Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Si-Yi Fu
- College of Clinical Medicine, North Sichuan Medical College, Nanchong, China
| | - Sheng-Xuan Zhang
- College of Clinical Medicine, North Sichuan Medical College, Nanchong, China
| | - Wan Yang
- College of Clinical Medicine, North Sichuan Medical College, Nanchong, China
| | - Yu-Jie Zuo
- College of Clinical Medicine, North Sichuan Medical College, Nanchong, China
| | - Hong-Tao Tang
- College of Clinical Medicine, North Sichuan Medical College, Nanchong, China
| | - Jun-Jie Yang
- College of Clinical Medicine, North Sichuan Medical College, Nanchong, China
| | - Pei-Zhi Liu
- College of Clinical Medicine, North Sichuan Medical College, Nanchong, China
| | - Hong-Ying Wen
- Department of Cardiothoracic Intensive Care Unit, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
- Correspondence: Dong Tian Hong-Ying Wen
| | - Dong Tian
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
- Department of Cardiothoracic Intensive Care Unit, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
- Academician (Expert) Workstation, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
- Correspondence: Dong Tian Hong-Ying Wen
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Tsou YL, Lee JM, Tang CC. The Trajectory of Cancer-Related Fatigue and Its Associating Factors in Patients with Esophageal Cancer Receiving Treatments: A Prospective Longitudinal Study. Ann Surg Oncol 2022; 29:2784-2790. [PMID: 34997418 DOI: 10.1245/s10434-021-11294-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 11/20/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Cancer-related fatigue (CRF) is the most distressing symptom in the overall cancer population. For patients with esophageal cancer, CRF may even be harder to predict and control due to its complicated and prolonged treatment. Moreover, communication difficulties due to disease progression or treatment may further diminish esophageal cancer patients' ability to communicate about CRF. However, little research has addressed the trajectory and associating factors of CRF in this population, especially during the active treatment phase. The purpose of this study was (1) to evaluate and compare the level of CRF at three time points, namely before treatment, a month after concurrent chemoradiotherapy (CCRT), and a week after surgery, and (2) to identify associated factors of CRF. METHODS This prospective cohort study used a questionnaire to evaluate esophageal cancer patients' CRF at three time points. Repeated measures ANOVA and linear regression were used to analyze the data. RESULTS This study included 73 participants. The severity of all CRF aspects intensified significantly over the course of treatment, reaching the highest level after surgery (P < 0.001). Worries of physician invalidation at baseline (P < 0.05) and marital status associated with CRF after CCRT and after surgery. CONCLUSIONS This is the first study to demonstrate the relationship between CRF and physician invalidation. Clinicians must be aware of the intensifying trend of CRF and provide timely intervention when caring for patients with esophageal cancer during cancer treatment. Reducing the worries of physician invalidation may alleviate CRF.
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Affiliation(s)
- Yi-Ling Tsou
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Jang-Ming Lee
- Department of Surgery, College of Medicine, National Taiwan University, Taipei, Taiwan.,Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Chia-Chun Tang
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan. .,Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan.
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Dalhammar K, Kristensson J, Falkenback D, Rasmussen BH, Malmström M. Symptoms, problems and quality of life in patients newly diagnosed with oesophageal and gastric cancer - a comparative study of treatment strategy. BMC Cancer 2022; 22:434. [PMID: 35448961 PMCID: PMC9022327 DOI: 10.1186/s12885-022-09536-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 04/11/2022] [Indexed: 12/24/2022] Open
Abstract
Background Patients with oesophageal and gastric cancer have a low likelihood of being cured and suffer from a broad spectrum of symptoms and problems that negatively affect their quality-of-life (QOL). Although the majority (67–75%) of patients at the time of diagnosis suffer from an incurable disease, research has primarily focused on the pre- and postoperative phase among patients treated with curative intent, with little attention to symptoms and problems in the diagnostic phase, especially in those who cannot be offered a cure. Methods In this cross-sectional study 158 patients newly diagnosed with oesophageal and gastric cancer visiting the surgical outpatient department for a preplanned care visit were included consecutively during 2018–2020. The validated instruments QLQ-C30 and QLQ-OG25, developed by the European Organization for Research and Treatment of Cancer (EORTC), and selected items from the Integrated Patient Outcome Scale (IPOS) were used to assess QOL, symptoms and problems. Differences between patients with a curative and a palliative treatment strategy were analysed using t-test and Mann–Whitney U test. The QLQ-C30 and QLQ-OG25 scores were compared to published reference data on the general Swedish population. Results Among all, the QOL was markedly lower, compared with general Swedish population (mean ± SD, 55.9 ± 24.7 vs 76.4 ± 22.8, p < 0.001). Compared to general population, the patients had significant impairment in all QOL aspects, particularly for role and emotional functioning and for symptoms such as eating-related problems, fatigue, insomnia and dyspnea. Majority of patients also reported severe anxiety among family and friends. Among patients with oesophageal cancer those with a palliative treatment strategy, compared with curative strategy, reported significantly lower QOL (mean ± SD, 50.8 ± 28.6 vs 62.0 ± 22.9 p = 0.030), physical (65.5 ± 22.6 vs 83.9 ± 16.5, p < 0.001) and role functioning (55.7 ± 36.6 vs 73.9 ± 33.3, p = 0.012), and a higher burden of several symptoms and problems. No significant differences between treatment groups were shown among patients with gastric cancer. Conclusions Patients newly diagnosed with oesophageal and gastric cancer, and especially those with incurable oesophageal cancer, have a severely affected QOL and several burdensome symptoms and problems. To better address patients’ needs, it seems important to integrate a palliative approach into oesophageal and gastric cancer care.
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Affiliation(s)
- Karin Dalhammar
- Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden. .,Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden.
| | - Jimmie Kristensson
- Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden.,Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Dan Falkenback
- Department of Surgery, Skåne University Hospital, Lund, Sweden.,Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden
| | - Birgit H Rasmussen
- Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden.,Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Marlene Malmström
- Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden.,Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
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10
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Bennett S, Murphy CF, Fanning M, Reynolds JV, Doyle SL, Donohoe CL. The impact of Nutrition and Gastrointestinal Symptoms on Health-related Quality of Life in Survivorship after Oesophageal Cancer Surgery. CLINICAL NUTRITION OPEN SCIENCE 2022. [DOI: 10.1016/j.nutos.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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11
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Gillman A, Hayes M, Sheaf G, Walshe M, Reynolds JV, Regan J. Exercise-based dysphagia rehabilitation for adults with oesophageal cancer: a systematic review. BMC Cancer 2022; 22:53. [PMID: 35012495 PMCID: PMC8751332 DOI: 10.1186/s12885-021-09155-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 12/24/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Dysphagia is prevalent in oesophageal cancer with significant clinical and psychosocial complications. The purpose of this study was i) to examine the impact of exercise-based dysphagia rehabilitation on clinical and quality of life outcomes in this population and ii) to identify key rehabilitation components that may inform future research in this area. METHODS Randomised control trials (RCT), non-RCTs, cohort studies and case series were included. 10 databases (CINAHL Complete, MEDLINE, EMBASE, Web of Science, CENTRAL, and ProQuest Dissertations and Theses, OpenGrey, PROSPERO, RIAN and SpeechBITE), 3 clinical trial registries, and relevant conference abstracts were searched in November 2020. Two independent authors assessed articles for eligibility before completing data extraction, quality assessment using ROBINS-I and Downs and Black Checklist, followed by descriptive data analysis. The primary outcomes included oral intake, respiratory status and quality of life. All comparable outcomes were combined and discussed throughout the manuscript as primary and secondary outcomes. RESULTS Three single centre non-randomised control studies involving 311 participants were included. A meta-analysis could not be completed due to study heterogeneity. SLT-led post-operative dysphagia intervention led to significantly earlier start to oral intake and reduced length of post-operative hospital stay. No studies found a reduction in aspiration pneumonia rates, and no studies included patient reported or quality of life outcomes. Of the reported secondary outcomes, swallow prehabilitation resulted in significantly improved swallow efficiency following oesophageal surgery compared to the control group, and rehabilitation following surgery resulted in significantly reduced vallecular and pyriform sinus residue. The three studies were found to have 'serious' to 'critical' risk of bias. CONCLUSIONS This systematic review highlights a low-volume of low-quality evidence to support exercise-based dysphagia rehabilitation in adults undergoing surgery for oesophageal cancer. As dysphagia is a common symptom impacting quality of life throughout survivorship, findings will guide future research to determine if swallowing rehabilitation should be included in enhanced recovery after surgery (ERAS) programmes. This review is limited by the inclusion of non-randomised control trials and the reliance on Japanese interpretation which may have resulted in bias. The reviewed studies were all of weak design with limited data reported.
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Affiliation(s)
- Anna Gillman
- Department of Clinical Speech and Language Studies, Trinity College Dublin, 7-9 South Leinster Street, Dublin 2, Ireland
| | - Michelle Hayes
- Speech and Language Therapy Department, St James' Hospital, James' Street, Dublin 8, D08 NHY1, Ireland
| | - Greg Sheaf
- The Library of Trinity College Dublin, Dublin 2, Ireland
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College Dublin, 7-9 South Leinster Street, Dublin 2, Ireland
| | - John V Reynolds
- Department of Surgery, St James' Hospital, James' Street, Dublin 8, D08 NHY1, Ireland
| | - Julie Regan
- Department of Clinical Speech and Language Studies, Trinity College Dublin, 7-9 South Leinster Street, Dublin 2, Ireland.
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12
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Toh Y, Morita M, Yamamoto M, Nakashima Y, Sugiyama M, Uehara H, Fujimoto Y, Shin Y, Shiokawa K, Ohnishi E, Shimagaki T, Mano Y, Sugimachi K. Health-related quality of life after esophagectomy in patients with esophageal cancer. Esophagus 2022; 19:47-56. [PMID: 34467435 DOI: 10.1007/s10388-021-00874-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 08/27/2021] [Indexed: 02/03/2023]
Abstract
Esophageal cancer is one of the malignant tumors with the poorest prognosis. Esophagectomy, which is the mainstay of curative-intent treatments, imposes excessive surgical stress on the patients, and postoperative morbidity and mortality rates after esophagectomy remain high. On the other hand, the number of survivors after esophagectomy for esophageal cancer is increasing due to recent improvements in surgical techniques and multidisciplinary treatments for this cancer. However, esophagectomy still has a great influence on the fundamental aspect of patients' lives, that is, the health-related quality of life (HR-QOL), including their physical, emotional, and social functions in the short- and long-term postoperatively. HR-QOL is a multifactorial concept used to assess the symptoms and functional changes caused by the disease itself and treatments from the patients' perspectives. Therefore, assessing the HR-QOL of patients with esophageal cancer after esophagectomy is becoming increasingly important. However, the status of HR-QOL changes after esophagectomy has not been satisfactorily evaluated, and there is no worldwide consensus as to how the postoperative HR-QOL can be improved. This review aimed to raise awareness of healthcare providers, such as surgeons and nurses, on the importance of HR-QOL in patients with esophageal cancer after curative-intent esophagectomy by providing multifaceted information concerning the short- and long-term HR-QOLs, including the status of changes and the determinants of HR-QOL after esophagectomy, and furthermore, essential points for improvement of HR-QOL after esophagectomy.
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Affiliation(s)
- Yasushi Toh
- Department of Gastroenterological Surgery, National Hospital Organization Kyushu Cancer Center, Fukuoka, 811-1395, Japan.
| | - Masaru Morita
- Department of Gastroenterological Surgery, National Hospital Organization Kyushu Cancer Center, Fukuoka, 811-1395, Japan
| | - Manabu Yamamoto
- Department of Gastroenterological Surgery, National Hospital Organization Kyushu Cancer Center, Fukuoka, 811-1395, Japan
| | - Yuichiro Nakashima
- Department of Gastroenterological Surgery, National Hospital Organization Kyushu Cancer Center, Fukuoka, 811-1395, Japan
| | - Masahiko Sugiyama
- Department of Gastroenterological Surgery, National Hospital Organization Kyushu Cancer Center, Fukuoka, 811-1395, Japan
| | - Hideo Uehara
- Department of Gastroenterological Surgery, National Hospital Organization Kyushu Cancer Center, Fukuoka, 811-1395, Japan
| | - Yoshiaki Fujimoto
- Department of Gastroenterological Surgery, National Hospital Organization Kyushu Cancer Center, Fukuoka, 811-1395, Japan
| | - Yuki Shin
- Department of Gastroenterological Surgery, National Hospital Organization Kyushu Cancer Center, Fukuoka, 811-1395, Japan
| | - Keiichi Shiokawa
- Department of Gastroenterological Surgery, National Hospital Organization Kyushu Cancer Center, Fukuoka, 811-1395, Japan
| | - Emi Ohnishi
- Department of Hepato-Biliary and Pancreatic Surgery, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Tomonari Shimagaki
- Department of Hepato-Biliary and Pancreatic Surgery, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Yohei Mano
- Department of Hepato-Biliary and Pancreatic Surgery, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Keishi Sugimachi
- Department of Hepato-Biliary and Pancreatic Surgery, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
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13
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Prediction of severe reflux after oesophageal cancer surgery. Eur J Surg Oncol 2021; 48:1011-1016. [PMID: 34872777 DOI: 10.1016/j.ejso.2021.11.134] [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: 06/24/2021] [Revised: 10/21/2021] [Accepted: 11/28/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION A common and burdensome consequence of oesophagectomy for cancer is reflux. This study aimed to develop a risk prediction model for postoperative reflux using variables available at the time of surgery enabling tailored preventive symptom management. METHODS Data were obtained from a nationwide, population-based cohort of 921 adults who underwent oesophagectomy for cancer between 2013 and 2019. Among 569 eligible patients, 383 (67%) participated in the study. Patient and clinical characteristics were retrieved from national health registries and medical records. Postoperative reflux was self-reported 1 year after surgery in the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire module for gastroesophageal symptoms. Multivariable regression models provided odds ratios (OR) with 95% confidence intervals (CI). The performance of the model was evaluated using the area under the receiver-operating characteristic curve. RESULTS Female sex (OR 2.24, 95% CI: 1.00-5.00), preoperative reflux (OR 2.99, 95% CI: 1.61-5.52), and preoperative body mass index ≥30 (OR 2.45, 95% CI: 1.32-4.54) increased the risk of postoperative reflux. A model based on age, sex, preoperative reflux, body mass index, chronic obstructive pulmonary disease, and ventricle substitute predicted 72% of the severe cases. CONCLUSION Female sex, preoperative reflux, and preoperative body mass index increased the risk of postoperative reflux. A combination of readily available patient and preoperative clinical variables showed fairly good accuracy in predicting postoperative reflux after oesophagectomy. The clinical risk prediction model may be helpful for early symptom management but needs to be externally validated before wider use.
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14
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Sunde B, Lindblad M, Malmström M, Hedberg J, Lagergren P, Nilsson M. Health-related quality of life one year after the diagnosis of oesophageal cancer: a population-based study from the Swedish National Registry for Oesophageal and Gastric Cancer. BMC Cancer 2021; 21:1277. [PMID: 34836512 PMCID: PMC8620917 DOI: 10.1186/s12885-021-09007-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 11/11/2021] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND Population-based patient reported outcome data in oesophageal cancer are rare. The main purpose of this study was to describe health-related quality of life (HRQOL) 1 year after the diagnosis of oesophageal cancer, comparing subgroups of curatively and palliatively managed patients. METHODS This is a nationwide population-based cohort study, based on the Swedish National Registry for Oesophageal and Gastric Cancer (NREV) with prospectively registered data, including HRQOL instruments from the European Organisation for Research and Treatment of Cancer including the core and disease specific questionnaires (EORTC QLQ-C30 and QLQ-OG25). Patients diagnosed with oesophageal cancer between 2009 and 2016 and with complete HRQOL data at 1 year follow-up were included. HRQOL of included patients was compared to a reference population matched by age and gender to to a previous cohort of unselected Swedish oesophageal cancer patients. Linear regression was performed to calculate mean scores with 95% confidence intervals (CI) and adjusted linear regression analysis was used to calculate mean score differences (MD) with 95% CI. RESULTS A total of 1156 patients were included. Functions and global health/quality of life were lower in both the curative and palliative cohorts compared to the reference population. Both curatively and palliatively managed patients reported a severe symptom burden compared to the reference population. Patients who underwent surgery reported more problems with diarrhoea compared to those treated with definitive chemoradiotherapy (dCRT) (MD -14; 95% CI - 20 to - 8). Dysphagia was more common in patiens treated with dCRT compared to surgically treated patients (MD 11; 95% CI 4 to 18). Those with palliative intent due to advanced tumour stage reported more problems with dysphagia compared to those with palliative intent due to frailty (MD -18; 95% CI - 33 to - 3). CONCLUSIONS One year after diagnosis both curative and palliative intent patients reported low function scores and severe symptoms. Dysphagia, choking, and other eating related problems were more pronounced in palliatively managed patients and in the curative intent patients treated with dCRT.
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Affiliation(s)
- Berit Sunde
- Division of Surgery, Department of Clinical Science Intervention and Technology, Karolinska Institutet and Department of Upper Abdominal Diseases, Karolinska University Hospital, SE-14186, Stockholm, Sweden.
| | - Mats Lindblad
- Division of Surgery, Department of Clinical Science Intervention and Technology, Karolinska Institutet and Department of Upper Abdominal Diseases, Karolinska University Hospital, SE-14186, Stockholm, Sweden
| | - Marlene Malmström
- Lund University, Department of Health Sciences and Department of surgery, Skane University Hospital, 221 85, Lund, Sweden
| | - Jakob Hedberg
- Department of Surgical Sciences, Uppsala University, 751 85, Uppsala, Sweden
| | - Pernilla Lagergren
- Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, 171 76, Stockholm, Sweden.,Department of Surgery and Cancer, Imperial College London, London, SW7 2AZ, UK
| | - Magnus Nilsson
- Division of Surgery, Department of Clinical Science Intervention and Technology, Karolinska Institutet and Department of Upper Abdominal Diseases, Karolinska University Hospital, SE-14186, Stockholm, Sweden
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15
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Schröder W, Gisbertz SS, Voeten DM, Gutschow CA, Fuchs HF, van Berge Henegouwen MI. Surgical Therapy of Esophageal Adenocarcinoma-Current Standards and Future Perspectives. Cancers (Basel) 2021; 13:5834. [PMID: 34830988 PMCID: PMC8616112 DOI: 10.3390/cancers13225834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 11/15/2021] [Accepted: 11/18/2021] [Indexed: 12/18/2022] Open
Abstract
Transthoracic esophagectomy is currently the predominant curative treatment option for resectable esophageal adenocarcinoma. The majority of carcinomas present as locally advanced tumors requiring multimodal strategies with either neoadjuvant chemoradiotherapy or perioperative chemotherapy alone. Minimally invasive, including robotic, techniques are increasingly applied with a broad spectrum of technical variations existing for the oncological resection as well as gastric reconstruction. At the present, intrathoracic esophagogastrostomy is the preferred technique of reconstruction (Ivor Lewis esophagectomy). With standardized surgical procedures, a complete resection of the primary tumor can be achieved in almost 95% of patients. Even in expert centers, postoperative morbidity remains high, with an overall complication rate of 50-60%, whereas 30- and 90-day mortality are reported to be <2% and <6%, respectively. Due to the complexity of transthoracic esophagetomy and its associated morbidity, esophageal surgery is recommended to be performed in specialized centers with an appropriate caseload yet to be defined. In order to reduce postoperative morbidity, the selection of patients, preoperative rehabilitation and postoperative fast-track concepts are feasible strategies of perioperative management. Future directives aim to further centralize esophageal services, to individualize surgical treatment for high-risk patients and to implement intraoperative imaging modalities modifying the oncological extent of resection and facilitating surgical reconstruction.
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Affiliation(s)
- Wolfgang Schröder
- Department of General, Visceral, Cancer and Transplantation Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany;
| | - Suzanne S. Gisbertz
- Cancer Center Amsterdam, Department of Surgery, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (S.S.G.); (D.M.V.); (M.I.v.B.H.)
| | - Daan M. Voeten
- Cancer Center Amsterdam, Department of Surgery, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (S.S.G.); (D.M.V.); (M.I.v.B.H.)
| | - Christian A. Gutschow
- Department of General and Transplantation Surgery, University Hospital Zurich, 8091 Zurich, Switzerland;
| | - Hans F. Fuchs
- Department of General, Visceral, Cancer and Transplantation Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany;
| | - Mark I. van Berge Henegouwen
- Cancer Center Amsterdam, Department of Surgery, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (S.S.G.); (D.M.V.); (M.I.v.B.H.)
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16
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Abstract
BACKGROUND Approximately 30% of patients suffer from severe reflux after surgery for esophageal cancer, which may serve as a continuous reminder of the cancer and catalyze fear of recurrence. OBJECTIVE The aim of this study was to investigate the association between severe reflux and symptoms of anxiety and depression after esophageal cancer surgery. METHODS This was a nationwide prospective cohort study including all Swedish patients who underwent esophageal cancer surgery between 2013 and 2018. Patients reported reflux on the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire module for gastroesophageal symptoms and psychological distress on the Hospital Anxiety and Depression Scale at 1 and 2 years after surgery. Repeated-measures logistic regression was used to calculate odds ratios (ORs) with 95% confidence intervals (CIs), adjusted for age, sex, comorbidity, body mass index, TNM classification, neoadjuvant therapy, surgery type, postoperative complications, antireflux medication, and elevated headrest at night. RESULTS Among 154 included patients, 43 (28%) and 37 (24%) reported severe reflux 1 and 2 years after surgery, respectively. No association between severe reflux and anxiety (OR, 2.1; 95% CI, 0.7-6.3) or depression (OR, 1.2; 95% CI, 0.3-4.6) was found 1 year after surgery. After 2 years, there was still no association between severe reflux and anxiety (OR, 0.9; 95% CI, 0.3-2.8) or depression (OR, 1.2; 95% CI, 0.5-3.3). CONCLUSIONS Findings suggest that severe reflux is not associated with anxiety or depression after esophageal cancer surgery. IMPLICATIONS FOR PRACTICE For esophageal cancer survivors, other factors than severe reflux may be more important for the psychological recovery.
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17
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Zhang W, Chen H, Zhang G, Jin G. A nomogram for predicting lymph node metastasis in superficial esophageal squamous cell carcinoma. J Biomed Res 2021; 35:361-370. [PMID: 34628403 PMCID: PMC8502689 DOI: 10.7555/jbr.35.20210034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/21/2021] [Accepted: 05/25/2021] [Indexed: 11/04/2022] Open
Abstract
Superficial esophageal squamous cell carcinoma (SESCC) is defined as carcinoma with mucosal or submucosal invasion, regardless of regional lymph node metastasis (LNM). The lymph node status is not only a key factor to determine the training strategy, but also the most important prognostic factor in esophageal cancer. In this study, we establish a clinical nomogram for predicting LNM in patients with SESCC. A predictive model was established based on the training cohort composed of 711 patients who underwent esophagectomy for SESCC from December 2009 to June 2018. A prospective cohort of 203 patients from June 2018 to January 2019 was used for validation. Favorable calibration and well-fitted decision curve analysis were conducted and good discrimination was observed (concordance index [C-index], 0.860; 95% confidence interval [CI], 0.825-0.894) through internal validation. The external validation cohort presented good discrimination (C-index, 0.916; 95% CI, 0.860-0.971). This model may facilitate the prediction of LNM in patients with SESCCs.
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Affiliation(s)
- Weifeng Zhang
- Department of Gastroenterology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210000, China
- The First Clinical Medical College of Nanjing Medical University, Nanjing, Jiangsu 210000, China
| | - Han Chen
- Department of Gastroenterology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210000, China
- The First Clinical Medical College of Nanjing Medical University, Nanjing, Jiangsu 210000, China
| | - Guoxin Zhang
- Department of Gastroenterology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210000, China
- The First Clinical Medical College of Nanjing Medical University, Nanjing, Jiangsu 210000, China
| | - Guangfu Jin
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu 211166, China
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18
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Allaire JC, Balk M, Azmi S, Handl HL, Yang K, Barnes G. Use of PD-1 and PD-L1 inhibitors after first-line therapy in esophageal cancer patients in the US. Curr Med Res Opin 2021; 37:1403-1407. [PMID: 33989092 DOI: 10.1080/03007995.2021.1929134] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Esophageal cancer (EC) makes up 3.2% of all cancers but ranks sixth among cancer-related deaths worldwide. This real-world analysis determined the use of PD-1/PD-L1 (PD[L]1) inhibitors in EC patients after receiving first-line therapy. METHODS Newly diagnosed EC patients initiating first-line treatment were identified in the IBM MarketScan administrative claims databases during the study period (1 May 2015 to 31 October 2020) using ICD-9/ICD-10 codes. Patients were assigned to either the chemotherapy only, radiation only, chemotherapy plus radiation (chemoradiation), or esophageal transhiatal/transthoracic surgery cohorts. RESULTS 7276 EC patients started first-line therapy (chemotherapy only = 2502, radiation only = 3355, chemoradiation = 1180, surgery = 239). The average age at diagnosis was 62 years and 23% were female. The median time from start of first-line therapy to utilization of a PD(L)1 inhibitor was 259 days. Pembrolizumab (72%) was the most frequently used PD(L)1 inhibitor across the three cohorts, followed by nivolumab (25%). Furthermore, the number of patients receiving a PD(L)1 inhibitor increased each year with the majority (73%) of use occurring between 2018 and 2020. DISCUSSION Findings from this real-world study suggest that PD(L)1 inhibitors are increasingly used after first-line therapies in EC, especially among patients initially receiving chemotherapy only. New immunological therapies such as PD(L)1 inhibitors hold great promise for patients with solid tumors. A clearer understanding of their real-world utilization is critical.
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Affiliation(s)
- Jason C Allaire
- Generativity Health Economics and Outcomes Research, Durham, NC, USA
- Department of Psychology, North Carolina State University, Raleigh, NC, USA
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19
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Sun C, Wang YT, Dai YJ, Liu ZH, Yang J, Cheng ZQ, Dong DS, Wang CF, Zhao GL, Lu GJ, Song T, Jin Y, Kaye AD, Imani F, Sadegi K, Sun LL, Sun YH. Programmable Pump for Intrathecal Morphine Delivery to Cisterna Magna: Clinical Implications in Novel Management of Refractory Pain Above Middle Thoracic Vertebrae Level Utilizing a Prospective Trial Protocol and Review. Anesth Pain Med 2021; 11:e115873. [PMID: 34540643 PMCID: PMC8438709 DOI: 10.5812/aapm.115873] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 05/19/2021] [Accepted: 05/19/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The cisterna Intrathecal Drug Delivery system (IDDS) with morphine has proven to be effective in treating refractory cancer pain above the middle thoracic vertebrae level in some countries. However, it has not been fully investigated in others. We designed the current project to investigate the efficacy and safety of cisterna IDDS for pain relief in refractory pain above the middle thoracic vertebrae level in advanced cancer patients. METHODS This study protocol allows for eligible cancer patients to receive the cisterna IDDS operation. Pain intensity (Visual Analogue scale, VAS), quality of life (36-Item Short-Form Health Survey, SF-36), and depression (Self-Rating Depression scale, SDS) are assessed along with side effects in the postoperative follow-up visits. Recent literature suggests a potential role for cisterna IDDS morphine delivery for refractory pain states above the middle thoracic level. CONCLUSION The results of this study may provide further evidence that cisterna IDDS of morphine can serve as an effective and safe pain relief strategy for refractory pain above the middle thoracic vertebrae level in advanced cancer patients.
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Affiliation(s)
- Chang Sun
- Department of Orthopedics, Xijing Hospital, The Fourth Military Medical University (Air Force Medical University), Xi’an, China
- Department of Anesthesiology, Anesthesia and Operation Center, Chinese PLA General Hospital, Beijing, China
| | - Yu-Tong Wang
- Department of Emergency, Xijing Hospital, The Fourth Military Medical University (Air Force Medical University), Xi’an, China
| | - Yu-Jie Dai
- Department of Clinical Nutrition, Xijing Hospital, The Fourth Military Medical University (Air Force Medical University), Xi’an, China
| | - Zhi-Hui Liu
- Department of Anesthesiology, Anesthesia and Operation Center, Chinese PLA General Hospital, Beijing, China
| | - Jing Yang
- Department of Anesthesiology, Anesthesia and Operation Center, Chinese PLA General Hospital, Beijing, China
| | - Zhu-Qiang Cheng
- Department of Anesthesiology, Pain Medicine Center, Jinling Hospital, Nanjing, China
| | - Dao-Song Dong
- Department of Pain Medicine, The First Affiliated Hospital of Chinese Medical University, Shenyang, China
| | - Cheng-Fu Wang
- Department of Pain Medicine, The First Affiliated Hospital of Chinese Medical University, Shenyang, China
| | - Guo-Li Zhao
- Department of Anesthesiology, Anesthesia and Operation Center, Chinese PLA General Hospital, Beijing, China
| | - Gui-Jun Lu
- Department of Anesthesiology, Anesthesia and Operation Center, Chinese PLA General Hospital, Beijing, China
| | - Tao Song
- Department of Pain Medicine, The First Affiliated Hospital of Chinese Medical University, Shenyang, China
| | - Yi Jin
- Department of Anesthesiology, Pain Medicine Center, Jinling Hospital, Nanjing, China
| | - Alan D. Kaye
- Department of Anesthesiology, LSU Health Shreveport, Shreveport, USA
- Corresponding Author: Department of Anesthesiology, LSU Health Shreveport, Shreveport, USA.
| | - Farnad Imani
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Kambiz Sadegi
- Department of Anesthesiology, Zabol University of Medical Sciences, Zabol, Iran
- Corresponding Author: Department of Anesthesiology, Zabol University of Medical Sciences, Zabol, Iran.
| | - Li-Li Sun
- Department of Neurology, Xijing Hospital, The Fourth Military Medical University (Air Force Medical University), Xi’an, China
| | - Yong-Hai Sun
- Department of Anesthesiology, Anesthesia and Operation Center, Chinese PLA General Hospital, Beijing, China
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20
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Nielsen S, Ringborg CH, Schandl A, Lagergren P. A qualitative study exploring patient's experiences of oesophageal cancer surgery, through their personal advice to future patients. Eur J Oncol Nurs 2021; 54:101983. [PMID: 34333385 DOI: 10.1016/j.ejon.2021.101983] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 05/12/2021] [Accepted: 05/18/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE Little is known about how patient's experience-based knowledge and advice after oesophageal cancer surgery may contribute to the understanding of how to improve HRQOL for future patients. In this study the advice that patients who were surgically treated for oesophageal cancer would like to share to future peers, based on their lived experiences were examined. METHOD A qualitative inductive content analysis was used to analyse one open-ended question from 63 transcribed interviews performed during 2019, within the nationwide Swedish prospective cohort study OSCAR (Oesophageal Surgery on Cancer patients - Adaption and Recovery study). RESULTS Patients had a broad range of advice to give from their experiences of oesophageal cancer surgery and recovery thereafter. Based on the analysis, three main categories were identified on the advice they wanted to pass on to future peers; health promoting advice, acknowledging the new situation, and advice on embracing support from others. The importance of being physically active, to maintain a positive mind set and to embrace support from both health care professionals as well as family and friends were central experiences that former patients wanted to share with their future peers. CONCLUSION This study sheds a light on the experiences that patients who have undergone oesophageal cancer surgery have, and what advice they would give to future patients going through the same procedure. The analysis reveals that patients have a variety of advice from their experiences that they want to pass on to future patients. Further studies are needed in order to examine how these advice are received by and can benefit future patients, as well as the pathways of how peer advice is best communicated.
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Affiliation(s)
- Sandra Nielsen
- Surgical Care Science, Department of Molecular medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - Cecilia H Ringborg
- Surgical Care Science, Department of Molecular medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - Anna Schandl
- Surgical Care Science, Department of Molecular medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, 171 76, Stockholm, Sweden; Department of Anaesthesiology and Intensive Care, Södersjukhuset, Stockholm, Sweden; Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Pernilla Lagergren
- Surgical Care Science, Department of Molecular medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, 171 76, Stockholm, Sweden; Department of Surgery and Cancer, Imperial College London, London, United Kingdom.
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21
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Piraux E, Reychler G, de Noordhout LM, Forget P, Deswysen Y, Caty G. What are the impact and the optimal design of a physical prehabilitation program in patients with esophagogastric cancer awaiting surgery? A systematic review. BMC Sports Sci Med Rehabil 2021; 13:33. [PMID: 33766107 PMCID: PMC7993458 DOI: 10.1186/s13102-021-00260-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 03/17/2021] [Indexed: 01/10/2023]
Abstract
Background Substantial postoperative complications occur after tumor resection for esophagogastric cancers. Physical prehabilitation programs aim to prepare patients for surgery by improving their functional status with the aim of reducing postoperative complications. This systematic review aims to summarize the effects of physical prehabilitation programs on exercise capacity, muscle strength, respiratory muscle function, postoperative outcomes, and health-related quality of life and to determine the optimal design of such a program to improve these outcomes in esophagogastric cancer patients undergoing tumor resection. Methods A systematic literature review was conducted using PubMed, The Cochrane Library, Scopus, and PEDro databases to identify studies evaluating the effects of physical prehabilitation program on exercise capacity, muscle strength, respiratory muscle function, postoperative complications, length of hospital stay, mortality, and health-related quality of life in patients with esophagogastric cancer awaiting surgery. Data from all studies meeting the inclusion criteria were extracted. The quality of each selected study was determined using the Downs and Black checklist. Results Seven studies with 645 participants were included. The preoperative exercise program consisted of respiratory training alone in three studies, a combination of aerobic and resistance training in two studies, and a combination of respiratory, aerobic, and resistance training in two studies. Training frequency ranged from three times a day to twice a week and each session lasted between 20 and 75 min. Four studies were of fair quality and three of good quality. Some studies reported improvements in maximal inspiratory pressure, inspiratory muscle endurance, postoperative (pulmonary) complications, and length of hospital stay in the preoperative exercise group compared to the control group. Conclusion This systematic review reports the current evidence for physical prehabilitation programs in patients with esophagogastric cancer awaiting surgery. However, due to the limited number of randomized controlled trials, the significant heterogeneity of exercise programs, and the questionable quality of the studies, higher quality randomized controlled trials are needed. Trial registration PROSPERO Registration Number: CRD42020176353. Supplementary Information The online version contains supplementary material available at 10.1186/s13102-021-00260-w.
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Affiliation(s)
- Elise Piraux
- Pôle de Neuro Musculo Skeletal Lab, Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab, Université catholique de Louvain, Avenue Mounier 53, bte B1.53.07, 1200, Brussels, Belgium. .,Pôle de Pneumologie, ORL & Dermatologie, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium. .,Clinical Neuroscience, Institute of Neurosciences, Université Catholique de Louvain, Brussels, Belgium.
| | - Gregory Reychler
- Pôle de Pneumologie, ORL & Dermatologie, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.,Haute Ecole Léonard de Vinci, Parnasse-ISEI, Brussels, Belgium.,Secteur de kinésithérapie, Cliniques universitaires Saint-Luc, Brussels, Belgium.,Service de Pneumologie, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Louise Maertens de Noordhout
- Pôle de Neuro Musculo Skeletal Lab, Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab, Université catholique de Louvain, Avenue Mounier 53, bte B1.53.07, 1200, Brussels, Belgium.,Pôle de Pneumologie, ORL & Dermatologie, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.,Clinical Neuroscience, Institute of Neurosciences, Université Catholique de Louvain, Brussels, Belgium
| | - Patrice Forget
- Department of Anaesthetics, Institute of Applied Health Sciences, Epidemiology Group, University of Aberdeen, NHS Grampian, Aberdeen, UK
| | - Yannick Deswysen
- Upper Gastrointestinal Surgery Unit, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Gilles Caty
- Pôle de Neuro Musculo Skeletal Lab, Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab, Université catholique de Louvain, Avenue Mounier 53, bte B1.53.07, 1200, Brussels, Belgium.,Clinical Neuroscience, Institute of Neurosciences, Université Catholique de Louvain, Brussels, Belgium.,Service de médecine physique et réadaptation, Cliniques universitaires Saint-Luc, Brussels, Belgium
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22
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Lidoriki I, Schizas D, Mylonas KS, Vergadis C, Karydakis L, Alexandrou A, Karavokyros I, Liakakos T. Postoperative Changes in Nutritional and Functional Status of Gastroesophageal Cancer Patients. J Am Coll Nutr 2021; 41:301-309. [PMID: 33704025 DOI: 10.1080/07315724.2021.1880986] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Disease-related malnutrition is a debilitating condition frequently observed in patients with cancer. The aim of the current study was to prospectively examine postoperative changes in nutritional and functional status of patients undergoing surgery for gastric, esophageal, and gastroesophageal junction cancer. METHODS Participants were prospectively recruited from September 2015 to September 2019. The assessment of malnutrition was based on the Patient-Generated Subjective Global Assessment tool. The functional assessment included the evaluation of muscle strength and physical performance, while muscle mass assessment was based on Skeletal Muscle Mass Index (SMI) derived from the analysis of computed tomography scans. The follow up of patients was scheduled at six months postoperatively. RESULTS A total of 98 patients were analyzed. Mean patient age was 60.79 ± 10.19 years and 80.6% were males. The mean unintentional weight loss at 6 months was 11.7 ± 8.0%. Patients who underwent McKeown esophagectomy reported the greatest weight loss postoperatively (16.2 ± 9.6%), whereas the lowest rate of weight loss was observed in patients who underwent partial gastrectomy (5.6 ± 6.7%). The rate of severe malnutrition declined at six months postoperatively (39.7% vs 27%). Muscle strength and physical performance were significantly deteriorated at 6 months postoperatively, except for the group of partial gastrectomy, while SMI significantly decreased in all groups of patients except for McKewon esophagectomy group. Finally, the prevalence of low muscle mass increased significantly from 43.5% in the preoperative period to 66.7% at the follow-up. CONCLUSIONS Our study revealed a significant deterioration in gastroesophageal cancer patient nutritional and functional status at six months postoperatively. The high prevalence of malnutrition and low muscle mass requires systematic follow-up and multidirectional monitoring in order to ensure the successful rehabilitation of these patients.
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Affiliation(s)
- Irene Lidoriki
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Konstantinos S Mylonas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | | | - Lysandros Karydakis
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Andreas Alexandrou
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Ioannis Karavokyros
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Theodoros Liakakos
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
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23
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Chung M, Benkli B, Roldan C, Qing Y, Wang J, Huh B. Subanesthetic ketamine in the ambulatory setting for refractory cancer pain: a 6-year retrospective at a cancer center. Pain Manag 2021; 11:267-276. [PMID: 33533283 DOI: 10.2217/pmt-2020-0083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Pain is common in advanced cancer is often refractory to standard treatment. Ketamine has shown promise as an effective adjuvant despite conflicting reports. The aim of this retrospective was to analyze the efficacy of subanesthetic ketamine infusion in the ambulatory setting over an extended follow-up period of 3 months for symptoms related to refractory cancer pain. Forty seven patients treated with intravenous ketamine infusion for refractory cancer pain at a tertiary referral cancer center. Patients demonstrated improvement from baseline in worst, mean, current and least pain immediately after treatment (p < 0.05), worst pain 1 month after treatment (p = 0.003), and current pain (p = 0.036) and worst pain (p = 0.002) 3 months after treatment. Symptoms of quality of life were followed 1 month after treatment.
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Affiliation(s)
- Matthew Chung
- Department of Pain Medicine, Division of Anesthesiology, Critical Care & Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Barlas Benkli
- Department of Neurology, The University of Texas McGovern Medical School, Houston, TX 77030, USA
| | - Carlos Roldan
- Department of Pain Medicine, Division of Anesthesiology, Critical Care & Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.,McGovern Medical School at the University of Texas Health Science, Houston, TX 77030, USA
| | - Yun Qing
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Jian Wang
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Billy Huh
- Department of Pain Medicine, Division of Anesthesiology, Critical Care & Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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24
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Lagergren P, Johar A, Rosenlund H, Arnberg L, Haglund L, Ness-Jensen E, Schandl A. Severe reflux, sleep disturbances, and health-related quality of life after esophageal cancer surgery. J Cancer Surviv 2021; 15:818-824. [PMID: 33502722 PMCID: PMC8519838 DOI: 10.1007/s11764-020-00974-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 11/25/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE Esophagectomy for cancer is an extensive procedure often followed by severe complications. This study investigated whether patients with severe symptoms of reflux are more likely to have sleep disturbances and reduced health-related quality of life (HRQL) after esophagectomy. METHODS This Swedish nationwide prospective cohort study encompassed all patients who had undergone esophagectomy for cancer between 2013 and 2018. One year after surgery, the patients responded to three questionnaires on reflux (EORTC QLQOG25), sleep disturbances (KSQ), and HRQL (EORTC QLQ-C30). Multivariable logistic regression provided odds ratios (OR) with 95% confidence intervals (CI) for sleep disturbance/reduced HRQL between patients with and without reflux, adjusted for potential confounders. RESULTS Among 241 esophagectomy patients, 66 (27%) reported severe reflux. Patients with reflux had an increased risk of sleep disturbances (OR 2.3, 95% CI: 1.3-4.3) compared to patients without reflux. More specifically, these patients were more likely to suffer from poor sleep quality (OR 4.9, 95% CI: 1.9-12.4). Patients with reflux and sleep disturbances reported reductions in global quality of life, role function, emotional function, social function, and more symptoms in all scales, except for dyspnea. CONCLUSIONS This study suggests that patients with severe symptoms of reflux after esophagectomy have an increased risk of sleep disturbances and poor sleep quality, which in turn are associated with reduced HRQL. IMPLICATIONS FOR CANCER SURVIVORS Alleviating reflux after oesophageal cancer surgery is important, since this common symptom might reduce HRQL and well-being.
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Affiliation(s)
- Pernilla Lagergren
- Surgical Care Science, Department of Molecular medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, 171 76, Stockholm, Sweden
- Department of Surgery & Cancer, Imperial College London, London, UK
| | - Asif Johar
- Surgical Care Science, Department of Molecular medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - Helen Rosenlund
- Surgical Care Science, Department of Molecular medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, 171 76, Stockholm, Sweden
- Division of Nutrition and Dietetics, Department of Orthopaedics, Danderyd Hospital, Stockholm, Sweden
| | - Lars Arnberg
- Patient research partnership group, Surgical Care Science, Department of Molecular medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - Lena Haglund
- Patient research partnership group, Surgical Care Science, Department of Molecular medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - Eivind Ness-Jensen
- Surgical Care Science, Department of Molecular medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, 171 76, Stockholm, Sweden
- HUNT Research Centre, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Levanger, Norway
- Department of Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Anna Schandl
- Surgical Care Science, Department of Molecular medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, 171 76, Stockholm, Sweden.
- Department of Anaesthesiology and Intensive Care, Södersjukhuset, Stockholm, Sweden.
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25
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Pattamatta M, Fransen LFC, Dolmans-Zwartjes ACP, Nieuwenhuijzen GAP, Evers SMAA, Kouwenhoven EA, van Det MJ, Hiligsmann M, Luyer MDP. Effect of direct oral feeding following minimally invasive esophagectomy on costs and quality of life. J Med Econ 2021; 24:54-60. [PMID: 33274674 DOI: 10.1080/13696998.2020.1859843] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AIMS Following (minimally invasive) esophagectomy, patients often rely on tube feeding, since oral intake is often delayed. Consequently, additional support by a dietician and home care is needed until oral intake is commenced. In this study, the effects of direct start of oral feeding compared with tube feeding following an esophagectomy was evaluated on treatment costs and health-related quality of life (QoL). METHODS Patients undergoing a minimally invasive esophagectomy were randomized in the NUTRIENT II study between controls (nil-per-mouth during 5 days and subsequent tube feeding) and a group in whom oral feeding was started directly postoperatively. Total hospital costs (including readmission and outpatient costs) and home care data for a period of 6 months after surgery were analyzed. QoL (measured using EORTC-QLQ-C30 and EORTC OG-25) was assessed preoperatively and 6 weeks, 12 weeks, and 6 months postoperatively. RESULTS A total 132 patients were included (n = 65 direct oral feeding group and n = 67 control group). Mean patient hospital costs were €26,014 in the intervention group over a 6-month period compared to €26,989 in the control group (p = .825). Furthermore, people with direct oral feeding required significantly less home care assistance; i.e. 23 (48.9%) intervention patients versus 37 (77.1%) control patients (p = .004). Also, QoL in patients with direct oral feeding progressed more quickly when compared to the control group. LIMITATIONS Hospital costs were derived from a single hospital unit whereas costs from all the participating units may be a better reflection of the cost deviation. Availability of homecare data was limited, leading to difficulty in detecting differences in costs. CONCLUSION This study suggests that direct oral feeding leads to similar total costs and a significantly reduced need for home care assistance. Furthermore, QoL in intervention group increased more quickly when compared to the control group.
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Affiliation(s)
- Madhuri Pattamatta
- Department of Surgery, Catharina Hospital, Michelangelolaan 2, Eindhoven, The Netherlands
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Laura F C Fransen
- Department of Surgery, Catharina Hospital, Michelangelolaan 2, Eindhoven, The Netherlands
| | | | | | - Silvia M A A Evers
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Trimbos Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | | | - Marc J van Det
- Department of Surgery, ZGT Hospital Group Twente, Almelo, The Netherlands
| | - Mickael Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Misha D P Luyer
- Department of Surgery, Catharina Hospital, Michelangelolaan 2, Eindhoven, The Netherlands
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26
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Chen H, Zhou X, Tang X, Li S, Zhang G. Prediction of Lymph Node Metastasis in Superficial Esophageal Cancer Using a Pattern Recognition Neural Network. Cancer Manag Res 2020; 12:12249-12258. [PMID: 33273861 PMCID: PMC7707435 DOI: 10.2147/cmar.s270316] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 10/29/2020] [Indexed: 12/12/2022] Open
Abstract
Background or Purpose It is important to predict nodal metastases in patients with early esophageal cancer to stratify patients for endoscopic resection or esophagectomy. This study was to establish a novel artificial neural network (ANN) and assess its ability by comparing it with a traditional logistic regression (LR) model for predicting lymph node (LN) metastasis in patients with superficial esophageal squamous cell carcinoma (SESCC). Methods A primary cohort was established, composed of 733 patients who underwent esophagectomy for SESCC from December 2012 to December 2019. The following steps were applied: (i) predictor selection; (ii) development of an ANN and a LR model, respectively; (iii) cross-validation; and (iv) evaluation of performance between the two models. The diagnostic assessment was performed with sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, C-index, net reclassification improvement (NRI), and integrated discrimination improvement (IDI). Results The established ANN model had 6 significant predictors: a past habit of alcohol taking, tumor size, submucosal invasion, histologic grade, lymph-vessel invasion, and preoperative CT result. The ANN model performed better than the LR model in specificity (91.20% vs 72.59%, p=0.006), PPV (56.49% vs 39.78%, p=0.020), accuracy (90.72% vs 74.49%, p<0.0001), C-index (91.5% vs 86.8%, p<0.001), and IDI (improved by 23.3%, p<0.001). There were no differences between these two models in sensitivity (87.06% vs 83.21%, p=0.764), NPV (98.17% vs 95.21%, p=0.627), and NRI (improved by −1.1%, p=0.824). Conclusion This ANN model is superior to the LR model and may become a valuable tool for the prediction of LN metastasis in patients with SESCC.
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Affiliation(s)
- Han Chen
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China.,The First Clinical Medical College, Nanjing Medical University, Nanjing, People's Republic of China
| | - Xiaoying Zhou
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China.,The First Clinical Medical College, Nanjing Medical University, Nanjing, People's Republic of China
| | - Xinyu Tang
- The First Clinical Medical College, Nanjing Medical University, Nanjing, People's Republic of China.,Department of Radiation Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Shuo Li
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China.,The First Clinical Medical College, Nanjing Medical University, Nanjing, People's Republic of China
| | - Guoxin Zhang
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China.,The First Clinical Medical College, Nanjing Medical University, Nanjing, People's Republic of China
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27
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Piraux E, Caty G, Reychler G, Forget P, Deswysen Y. Feasibility and Preliminary Effectiveness of a Tele-Prehabilitation Program in Esophagogastric Cancer Patients. J Clin Med 2020; 9:jcm9072176. [PMID: 32660126 PMCID: PMC7408844 DOI: 10.3390/jcm9072176] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/22/2020] [Accepted: 07/06/2020] [Indexed: 12/13/2022] Open
Abstract
Tele-rehabilitation provides better access to healthcare services and optimizes exercise adherence. However, its feasibility and effectiveness are unknown in the preoperative period in esophagogastric cancer patients. We aimed to assess the feasibility and the preliminary effects of a “tele-prehabilitation” program in esophagogastric cancer patients requiring surgery. Enrolled participants performed an internet-based tele-prehabilitation including aerobic, resistance and inspiratory muscle training over 2–4 weeks. The primary outcome was feasibility, measured in terms of recruitment, retention and attendance rates, adverse events and patient satisfaction. Secondary outcomes (functional exercise capacity, fatigue, quality of life, anxiety and depression) were assessed at baseline, presurgery, and 4 and 12 weeks postsurgery. Among the 24 eligible subjects, 23 were enrolled, 22 performed the intervention and 15 completed the study. Recruitment and retention rates were both 96%. Attendances to aerobic and resistance sessions and inspiratory muscle training were 77% and 68%, respectively. No adverse events occurred, and the satisfaction was excellent. After prehabilitation, participants significantly improved fatigue (p = 0.039), quality of life (p = 0.009), physical well-being (p = 0.034), emotional well-being (p = 0.005) and anxiety (p = 0.044). This study demonstrated the feasibility of a tele-prehabilitation in esophagogastric cancer patients undergoing surgery, with a high recruitment rate, retention rate and satisfaction, a good attendance to exercise sessions and no exercise-related adverse events.
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Affiliation(s)
- Elise Piraux
- Pôle de Neuro Musculo Skeletal Lab, Pôle de Pneumologie, ORL & Dermatologie, Institut de Recherche Expérimentale et Clinique, Clinical Neuroscience, Institute of Neurosciences, Université Catholique de Louvain, 1200 Brussels, Belgium
- Correspondence:
| | - Gilles Caty
- Pôle de Neuro Musculo Skeletal Lab, Institut de Recherche Expérimentale et Clinique, Clinical Neuroscience, Institute of Neurosciences, Université Catholique de Louvain, Service de Médecine Physique et Réadaptation, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium;
| | - Gregory Reychler
- Pôle de Pneumologie, ORL & Dermatologie, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Haute Ecole Léonard de Vinci, PARNASSE-ISEI, Secteur de kinésithérapie, Service de Pneumologie, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium;
| | - Patrice Forget
- Institute of Applied Health Sciences, Epidemiology Group, University of Aberdeen, NHS Grampian, Department of Anaesthetics, Aberdeen AB25 2ZD, UK;
| | - Yannick Deswysen
- Upper Gastrointestinal Surgery Unit, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium;
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28
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Janssen HJ, Fransen LF, Ponten JE, Nieuwenhuijzen GA, Luyer MD. Micronutrient Deficiencies Following Minimally Invasive Esophagectomy for Cancer. Nutrients 2020; 12:E778. [PMID: 32183492 PMCID: PMC7146612 DOI: 10.3390/nu12030778] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 03/05/2020] [Accepted: 03/13/2020] [Indexed: 12/15/2022] Open
Abstract
Over the past decades, survival rates for patients with resectable esophageal cancer have improved significantly. Consequently, the sequelae of having a gastric conduit, such as development of micronutrient deficiencies, become increasingly apparent. This study investigated postoperative micronutrient trends in the follow-up of patients following a minimally invasive esophagectomy (MIE) for cancer. Patients were included if they had at least one postoperative evaluation of iron, ferritin, vitamins B1, B6, B12, D, folate or methylmalonic acid. Data were available in 83 of 95 patients. Of these, 78.3% (65/83) had at least one and 37.3% (31/83) had more than one micronutrient deficiency at a median of 6.1 months (interquartile range (IQR) 5.4-7.5) of follow-up. Similar to the results found in previous studies, most common deficiencies identified were: iron, vitamin B12 and vitamin D. In addition, folate deficiency and anemia were detected in a substantial amount of patients in this cohort. At 24.8 months (IQR 19.4-33.1) of follow-up, micronutrient deficiencies were still common, however, most deficiencies normalized following supplementation on indication. In conclusion, patients undergoing a MIE are at risk of developing micronutrient deficiencies as early as 6 up to 24 months after surgery and should therefore be routinely checked and supplemented when needed.
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Affiliation(s)
| | | | | | | | - Misha D.P. Luyer
- Department of Surgery, Catharina Hospital, Eindhoven, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands
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29
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Sunde B, Klevebro F, Johar A, Johnsen G, Jacobsen AB, Glenjen NI, Friesland S, Lindblad M, Ajengui A, Lundell L, Lagergren P, Nilsson M. Health-related quality of life in a randomized trial of neoadjuvant chemotherapy or chemoradiotherapy plus surgery in patients with oesophageal cancer (NeoRes trial). Br J Surg 2019; 106:1452-1463. [PMID: 31436322 DOI: 10.1002/bjs.11246] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 04/02/2019] [Accepted: 05/02/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND There are few data comparing health-related quality of life (HRQoL) after neoadjuvant chemotherapy alone (nCT) compared with neoadjuvant chemoradiotherapy (nCRT) in patients with oesophageal cancer. METHODS In the NeoRes trial, patients were assigned randomly in a 1 : 1 ratio to receive either cisplatin 100 mg/m2 on day 1 and an infusion of 750 mg per m2 5-fluorouracil over 24 h on days 1-5 in three 21-day cycles (nCT) or the same chemotherapy regimen, but with the addition of 40 Gy radiotherapy (nCRT). HRQoL data were collected at baseline, after neoadjuvant therapy and at 1, 3 and 5 years after surgery. The European Organisation for Research and Treatment of Cancer (EORTC) core questionnaire QLQ-C30 and disease-specific modules were used. RESULTS Of 181 patients randomized, 165 were included in the analysis of HRQoL. In a direct comparison between the allocated treatments, odynophagia after completion of neoadjuvant therapy but before surgery (P = 0·047) and troublesome coughing at 3 years' follow-up (P = 0·011) were more pronounced in the nCRT arm. In the longitudinal analyses within each treatment arm, a large deterioration in HRQoL was noted at 1 year. Some recovery was seen in both arms over time but, after 3 and 5 years, patients in the nCRT arm reported more symptoms compared with baseline than patients in the nCT arm. CONCLUSION HRQoL after multimodal treatment for cancer of the oesophagus or gastro-oesophageal junction was impaired and more pronounced in patients who underwent nCRT, with only partial recovery over time.
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Affiliation(s)
- B Sunde
- Division of Surgery, Department of Clinical Science Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - F Klevebro
- Division of Surgery, Department of Clinical Science Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - A Johar
- Department of Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - G Johnsen
- Department of Gastrointestinal Surgery, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - A-B Jacobsen
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - N I Glenjen
- Department of Oncology, Haukeland University Hospital, Bergen, Norway
| | - S Friesland
- Department of Oncology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - M Lindblad
- Division of Surgery, Department of Clinical Science Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - A Ajengui
- Division of Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - L Lundell
- Division of Surgery, Department of Clinical Science Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - P Lagergren
- Department of Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - M Nilsson
- Division of Surgery, Department of Clinical Science Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
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Sugawara K, Yoshimura S, Yagi K, Nishida M, Aikou S, Yamagata Y, Mori K, Yamashita H, Seto Y. Long-term health-related quality of life following robot-assisted radical transmediastinal esophagectomy. Surg Endosc 2019; 34:1602-1611. [DOI: 10.1007/s00464-019-06923-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 06/12/2019] [Indexed: 02/08/2023]
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Baudry AS, Anota A, Mariette C, Bonnetain F, Renaud F, Piessen G, Christophe V. The role of trait emotional intelligence in quality of life, anxiety and depression symptoms after surgery for esophageal or gastric cancer: A French national database FREGAT. Psychooncology 2019; 28:799-806. [PMID: 30734393 DOI: 10.1002/pon.5023] [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: 10/08/2018] [Revised: 02/04/2019] [Accepted: 02/05/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The main objective was to test the indirect effects of emotional competence (EC) after diagnosis (T1) on the health-related quality of life (HRQoL) after surgery (T2) of esogastric cancer patients via fewer anxiety and depression symptoms (T2). METHODS Data were collected from 30 French centers via the clinicobiological database French EsoGastric Tumors (FREGAT). Two hundred and twenty-eight participants completed a self-reported questionnaire at T1 and T2, assessing their EC (Profile of Emotional Competence (PEC)), HRQoL (EORTC Quality of Life Questionnaire-Core (QLQ-C30)), and anxiety and depression symptoms (Hospital Anxiety and Depression Scale (HADS)). Regression analyses were used to test the direct effects of intrapersonal and interpersonal EC on their anxiety/depression symptoms and HRQoL at T1 and T2. The PROCESS Macro in SPPS v.22 with bootstrap methods was used to test the indirect effects of intrapersonal and interpersonal EC at T1 on HRQoL at T2 via anxiety and depression symptoms. RESULTS EC predicted fewer anxiety and depression symptoms of patients at T1 and T2 and better HRQoL at T1. EC at T1 also predicted a better HRQoL at T2 via fewer anxiety and depression symptoms at T2. CONCLUSIONS Patients who tended to use their EC in daily life could be more effective in regulating the emotional impact of the cancer diagnosis and surgery. This explains why they reported fewer anxiety and depression symptoms, which in turn enabled a better perceived HRQoL after surgery. Therefore, reinforcing the use of patients' EC in daily life following their diagnosis could decrease their emotional distress and, in this way, improve their HRQoL in the preoperative and postoperative stages.
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Affiliation(s)
- Anne-Sophie Baudry
- Affective and Cognitive Sciences, University Lille, UMR CNRS 9193-SCALab, Villeneuve d'Ascq Cedex, France
| | - Amelie Anota
- Methodology and Quality of Life in Oncology Unit (INSERM UMR 1098), University Hospital of Besançon, Besançon, France
| | - Christophe Mariette
- Department of Digestive and Oncological Surgery, University Lille, Claude Huriez University Hospital, Lille Cedex, France.,Jean-Pierre Aubert Research Center, Neurosciences and Cancer, University Lille, UMR-S 1172-JPArc, Lille, France
| | - Franck Bonnetain
- Methodology and Quality of Life in Oncology Unit (INSERM UMR 1098), University Hospital of Besançon, Besançon, France
| | - Florence Renaud
- Jean-Pierre Aubert Research Center, Neurosciences and Cancer, University Lille, UMR-S 1172-JPArc, Lille, France.,Department of Pathology, Biology Pathology Center, University Lille, University Hospital, Lille, France
| | - Guillaume Piessen
- Department of Digestive and Oncological Surgery, University Lille, Claude Huriez University Hospital, Lille Cedex, France.,Jean-Pierre Aubert Research Center, Neurosciences and Cancer, University Lille, UMR-S 1172-JPArc, Lille, France
| | - Veronique Christophe
- Affective and Cognitive Sciences, University Lille, UMR CNRS 9193-SCALab, Villeneuve d'Ascq Cedex, France
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Effect of comorbid depression on health-related quality of life of patients with chronic diseases: A South Korean nationwide study (2007-2015). J Psychosom Res 2019; 116:17-21. [PMID: 30654988 DOI: 10.1016/j.jpsychores.2018.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 11/08/2018] [Accepted: 11/08/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Patients with chronic physical diseases often have concomitant depression. Depression influences an individual's health and his or her overall health-related quality of life (HRQoL). The extent to which depression incrementally worsens HRQoL in patients with ≥1 comorbid physical chronic diseases remains unclear. METHODS This cross-sectional study is based on data of 50,844 respondents (age, ≥19 years) who participated in the Korean National Health and Nutrition Examination Survey (KNHANES) (2007-2015). HRQoL was measured using the modified EuroQol five-dimensional (EQ-5D) score. Mean HRQoL scores were compared between subgroups of respondents with or without depression. The association between HRQoL and disease status was evaluated using multiple regression models after controlling for sociodemographic variables. RESULTS HRQoL score decreased when depression was concomitant. HRQoL score of respondents who had ≥3 chronic diseases with concomitant depression (mean = 0.83, SE = 0.010) were significantly lower (p = 0.002) than those of respondents who had ≥3 chronic diseases but no concomitant depression (mean = 0.87, SE = 0.007). Moreover, respondents with ≥3 chronic diseases comorbid with depression showed the largest negative association (coefficient = -0.133, p < 0.001) with HRQoL among all disease status groups. CONCLUSION Presence of depression incrementally worsened individual's HRQoL when comorbid with other physical diseases. Especially, depression showed substantial negative effect on HRQoL level in patients with ≥2 physical diseases.
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Malik S, Sharma G, Sanaka MR, Thota PN. Role of endoscopic therapy in early esophageal cancer. World J Gastroenterol 2018; 24:3965-3973. [PMID: 30254401 PMCID: PMC6148428 DOI: 10.3748/wjg.v24.i35.3965] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 07/23/2018] [Accepted: 08/01/2018] [Indexed: 02/06/2023] Open
Abstract
Esophageal carcinoma is a highly lethal cancer associated with high morbidity and mortality. Esophageal squamous cell carcinoma and esophageal adenocarcinoma are the two distinct histological types. There has been significant progress in endoscopic diagnosis and treatment of early stages of cancer using resection and ablation techniques, as shown in several trials in the recent past. Earlier detection of esophageal cancer and advances in treatment modalities have lead to improvement in the 5-year survival from 5% to about 20% in the past decade. Endoscopic eradication therapy is the preferred modality of treatment in cancer limited to mucosal layer of the esophagus as there is very low risk of lymph node metastasis, leading to high cure rates, low risk of recurrence and with few adverse effects. The most common adverse events seen are strictures, bleeding and rarely perforation which can be endoscopically managed. In patients with recurrent advanced disease or invasive tumor, esophagectomy with lymph node dissection remains the mainstay of treatment. There is debate on post-endoscopic surveillance with some studies suggesting closer follow up with upper endoscopy every 6 mo for the first 1-2 years and then annually for the 3 years while others recommending the appropriate action only if symptoms or other abnormalities develop. Overall, the field of endoscopic therapy is still evolving and focus should be placed on careful patient selection using a multidisciplinary approach.
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Affiliation(s)
- Sonika Malik
- Department of Internal Medicine, Cleveland Clinic Akron General Medical Center, Akron, OH 44307, United States
| | - Gautam Sharma
- Department of Anesthesiology, University Hospitals, Cleveland, OH 44106, United States
| | - Madhusudhan R Sanaka
- Department of Gastroenterology, Digestive Disease Surgery Institute, Cleveland Clinic, OH 44195, United States
| | - Prashanthi N Thota
- Department of Gastroenterology, Digestive Disease Surgery Institute, Cleveland Clinic, OH 44195, United States
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Abstract
BACKGROUND Previous literature has reported that regular physical activity enhances health-related quality of life for cancer patients. However, there is a lack of studies that focus on physical activity among postoperative esophageal cancer patients. OBJECTIVE The aims of this study were to (1) describe the prevalence of physical activity among postoperative esophageal cancer patients, (2) explore variables related to physical activity (demographics, nutrition, dysphagia, and health-related qualify of life), and (3) examine potential reasons for inactivity among participants who scored low using case studies. METHODS In this cross-sectional design, physical activity was evaluated by the Japanese version of the International Physical Activity Questionnaire. Variables were analyzed using Spearman rank correlation coefficients, Mann-Whitney U tests, or Fisher exact tests. RESULTS Fifty-eight patients participated in this study; 79% met the recommended physical activity guidelines. Present occupational status and past leisure-time physical activity behavior before the cancer diagnosis were related to current leisure-time physical activity and meeting the guidelines postoperatively. Participants who scored 0 (little or no activity) in the questionnaire also scored low in health-related quality of life. CONCLUSIONS Participants performed especially well in physical activity related to leisure time and transportation. Positive reinforcement is needed for patients who perform adequate levels of physical activity, and reviewing the benefits of regular physical activity is encouraged for all. IMPLICATIONS FOR PRACTICE Occupational status and past leisure-time physical activity before diagnosis can be indicators for promoting physical activity among postoperative esophageal cancer patients. Inactive participants should be supported to promote both physical activity and health-related qualify of life.
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Anderson C, Park EM, Rosenstein DL, Nichols HB. Suicide rates among patients with cancers of the digestive system. Psychooncology 2018; 27:2274-2280. [PMID: 29956393 PMCID: PMC6584762 DOI: 10.1002/pon.4827] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 06/19/2018] [Accepted: 06/20/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Previous studies have suggested that suicide rates are elevated among cancer patients relative to the general population. In this analysis, we comprehensively evaluated characteristics associated with higher suicide rates among patients with cancers of the digestive system. METHODS Using the United States Surveillance, Epidemiology, and End Results database, we identified all patients diagnosed with digestive system cancers during 2000 to 2014. Patients were classified as having died of suicide if their cause of death in Surveillance, Epidemiology, and End Results was listed as "suicide and self-inflicted injury." Suicide rates were compared to age-, sex-, and race-adjusted rates in the general population. RESULTS A total of 881 suicides were identified among 856 293 patients diagnosed with digestive system cancers. The suicide rate in this population was 32.8 per 100 000 person-years and was nearly twice that in the general population (standardized mortality ratio [SMR] = 1.91; 95% CI, 1.79-2.04). Suicide rates were significantly elevated for all cancer sites but were highest for esophageal (SMR = 5.03), pancreatic (SMR = 5.28), stomach (SMR = 2.84), and liver (SMR = 2.14) cancers. Standardized mortality ratios for suicide were highest within the first 5 years of diagnosis and increased with age at diagnosis for all sites except colon and stomach. CONCLUSIONS Patients with cancers of the digestive system have a higher incidence of suicide than the general population. Suicide rates among esophageal and pancreatic cancer patients are more than 5 times general population rates. The involvement of psychiatrists and other mental health professionals may be a critical component of cancer care for these high-risk patient subgroups.
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Affiliation(s)
- Chelsea Anderson
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Eliza M. Park
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Donald L. Rosenstein
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Hazel B. Nichols
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
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Zhang Y, Yang X, Geng D, Duan Y, Fu J. The change of health-related quality of life after minimally invasive esophagectomy for esophageal cancer: a meta-analysis. World J Surg Oncol 2018; 16:97. [PMID: 29793487 PMCID: PMC5968615 DOI: 10.1186/s12957-018-1330-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 02/04/2018] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Short- and long-term health-related quality of life (HRQL) was severely affected after surgery. This study aimed to assess the direction and duration of HRQL from 3- to 24-month follow-ups after minimally invasive esophagectomy (MIE) for esophageal cancer. METHODS A systematic literature search in MEDLINE, EMBASE, and the Cochrane database was performed for all potentially relevant studies published until February 2017. Studies were included if they addressed the question of HRQL with OERTC-QLQ-C30 and OES18. Primary outcomes were HRQL change at 3-month follow-up. Secondary outcomes were HRQL change from 3-, 6- (short-term) to 12- (mid-term), and/or 24-month (long-term) follow-ups. RESULTS Six articles were included to estimate the change in 24 HRQL outcomes after MIE. Most of the patients' HRQL outcomes deteriorated at short-term follow-up and some lasted to mid- or long-term after MIE. Patients' physical function and global QOL deteriorated from short- to long-term follow-ups, and emotional function had no change. The directions of dyspnea, pain, fatigue, insomnia, constipation, diarrhea, cough, and speech problems were increased. The deterioration in global function lasted 6 months, the increase in constipation and speech problems lasted 12 months, and insomnia increased more than 12 months after MIE. CONCLUSIONS The emotional function had no change after MIE. The global QOL become worse during early postoperative period; the symptoms of constipation, speech problems, and insomnia increased for a long time after MIE.
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Affiliation(s)
- Yong Zhang
- Department of Thoracic Surgery, the First Affiliated Hospital of Xi’an Jiaotong University, No. 277 West Yanta Road, Xi’an, 710061 China
| | - Xiaomei Yang
- Hospital 521 of China’s Ordnance Industry Group, Xi’an, 710065 China
| | - Donghong Geng
- School of Continuing Education of Xi’an Jiaotong University, Xi’an, 710061 China
| | - Yingfei Duan
- Department of Pathology, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, 710061 China
| | - Junke Fu
- Department of Thoracic Surgery, the First Affiliated Hospital of Xi’an Jiaotong University, No. 277 West Yanta Road, Xi’an, 710061 China
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van den Boorn HG, Engelhardt EG, van Kleef J, Sprangers MAG, van Oijen MGH, Abu-Hanna A, Zwinderman AH, Coupé VMH, van Laarhoven HWM. Prediction models for patients with esophageal or gastric cancer: A systematic review and meta-analysis. PLoS One 2018; 13:e0192310. [PMID: 29420636 PMCID: PMC5805284 DOI: 10.1371/journal.pone.0192310] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 01/22/2018] [Indexed: 02/06/2023] Open
Abstract
Background Clinical prediction models are increasingly used to predict outcomes such as survival in cancer patients. The aim of this study was threefold. First, to perform a systematic review to identify available clinical prediction models for patients with esophageal and/or gastric cancer. Second, to evaluate sources of bias in the included studies. Third, to investigate the predictive performance of the prediction models using meta-analysis. Methods MEDLINE, EMBASE, PsycINFO, CINAHL, and The Cochrane Library were searched for publications from the year 2000 onwards. Studies describing models predicting survival, adverse events and/or health-related quality of life (HRQoL) for esophageal or gastric cancer patients were included. Potential sources of bias were assessed and a meta-analysis, pooled per prediction model, was performed on the discriminative abilities (c-indices). Results A total of 61 studies were included (45 development and 16 validation studies), describing 47 prediction models. Most models predicted survival after a curative resection. Nearly 75% of the studies exhibited bias in at least 3 areas and model calibration was rarely reported. The meta-analysis showed that the averaged c-index of the models is fair (0.75) and ranges from 0.65 to 0.85. Conclusion Most available prediction models only focus on survival after a curative resection, which is only relevant to a limited patient population. Few models predicted adverse events after resection, and none focused on patient’s HRQoL, despite its relevance. Generally, the quality of reporting is poor and external model validation is limited. We conclude that there is a need for prediction models that better meet patients’ information needs, and provide information on both the benefits and harms of the various treatment options in terms of survival, adverse events and HRQoL.
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Affiliation(s)
- H. G. van den Boorn
- Cancer Center Amsterdam, Amsterdam, The Netherlands
- Department of Medical Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- * E-mail:
| | - E. G. Engelhardt
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - J. van Kleef
- Cancer Center Amsterdam, Amsterdam, The Netherlands
- Department of Medical Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - M. A. G. Sprangers
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - M. G. H. van Oijen
- Cancer Center Amsterdam, Amsterdam, The Netherlands
- Department of Medical Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - A. Abu-Hanna
- Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - A. H. Zwinderman
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - V. M. H. Coupé
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - H. W. M. van Laarhoven
- Cancer Center Amsterdam, Amsterdam, The Netherlands
- Department of Medical Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Mantoan S, Cavallin F, Pinto E, Saadeh LM, Alfieri R, Cagol M, Bellissimo MC, Castoro C, Scarpa M. Long-term quality of life after esophagectomy with gastric pull-up. J Surg Oncol 2018; 117:970-976. [PMID: 29409116 DOI: 10.1002/jso.24995] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 01/04/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND OBJECTIVES Data on long-term health-related quality of life (HRQL) after esophagectomy for cancer show contradictory results. The aim was to analyze long-term HRQL at 3 or more years after esophagectomy. METHODS Survivors were identified among patients who had undergone esophagectomy during 2007-2013 using the local clinic database. Quality of life was assessed using the European Organization for Research and Treatment of Cancer QLQ-C30 and OG25 questionnaires. Specific aspects were selected a priori and compared with published scores from European healthy subjects (mean difference, MD). RESULTS Sixty-five long-term survivors (median follow-up 4 years) were identified. All functional scales and most symptom scales were clinically similar between EC long-term survivors and European healthy subjects. Survivors reported more problems concerning eating (MD 13.1, 95% C.I. 10.6-15.6) and reflux (MD 19.7, 95% C.I. 15.9-23.5). HQRL variation from discharge to long term was available in 27 participants who reported improvements in role functioning (MD 40.1, 95%C.I. 24.3-56.0) and dysphagia (MD -41.9, 95% C.I. -51.7 to 32.0). CONCLUSIONS Long-term HRQL after esophagectomy is similar between EC survivors and European healthy subjects, despite persisting reflux and eating problems. Further research may focus on improvements of postoperative alimentary habits.
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Affiliation(s)
- Silvia Mantoan
- Surgical Oncology Unit, Veneto Institute of Oncology IOV IRCCS, Padua, Italy
| | - Francesco Cavallin
- Surgical Oncology Unit, Veneto Institute of Oncology IOV IRCCS, Padua, Italy
| | - Eleonora Pinto
- Surgical Oncology Unit, Veneto Institute of Oncology IOV IRCCS, Padua, Italy
| | - Luca M Saadeh
- Surgical Oncology Unit, Veneto Institute of Oncology IOV IRCCS, Padua, Italy
| | - Rita Alfieri
- Surgical Oncology Unit, Veneto Institute of Oncology IOV IRCCS, Padua, Italy
| | - Matteo Cagol
- Surgical Oncology Unit, Veneto Institute of Oncology IOV IRCCS, Padua, Italy
| | - Maria C Bellissimo
- Surgical Oncology Unit, Veneto Institute of Oncology IOV IRCCS, Padua, Italy
| | - Carlo Castoro
- Surgical Oncology Unit, Veneto Institute of Oncology IOV IRCCS, Padua, Italy
| | - Marco Scarpa
- Surgical Oncology Unit, Veneto Institute of Oncology IOV IRCCS, Padua, Italy
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Linder G, Sandin F, Johansson J, Lindblad M, Lundell L, Hedberg J. Patient education-level affects treatment allocation and prognosis in esophageal- and gastroesophageal junctional cancer in Sweden. Cancer Epidemiol 2018; 52:91-98. [DOI: 10.1016/j.canep.2017.12.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 12/14/2017] [Accepted: 12/16/2017] [Indexed: 10/18/2022]
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Abstract
Oesophageal cancer is a clinically challenging disease that requires a multidisciplinary approach. Extensive treatment might be associated with a considerable decline in health-related quality of life and yet still a poor prognosis. In recent decades, prognosis has gradually improved in many countries. Endoscopic procedures have increasingly been used in the treatment of premalignant and early oesophageal tumours. Neoadjuvant therapy with chemotherapy or chemoradiotherapy has supplemented surgery as standard treatment of locally advanced oesophageal cancer. Surgery has become more standardised and centralised. Several therapeutic alternatives are available for palliative treatment. This Seminar aims to provide insights into the current clinical management, ongoing controversies, and future needs in oesophageal cancer.
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Affiliation(s)
- Jesper Lagergren
- Division of Cancer Studies, King's College London, Guy's and St Thomas' NHS Foundation Trust, London, UK; Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
| | - Elizabeth Smyth
- Department of Gastrointestinal Oncology, The Royal Marsden NHS Foundation Trust, London, UK
| | - David Cunningham
- Department of Gastrointestinal Oncology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Pernilla Lagergren
- Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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Graham-Wisener L, Dempster M. Peer advice giving from posttreatment to newly diagnosed esophageal cancer patients. Dis Esophagus 2017; 30:1-7. [PMID: 28859397 DOI: 10.1093/dote/dox089] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 06/13/2017] [Indexed: 12/11/2022]
Abstract
The benefits of peer support in cancer care include the sharing of information and experience, supporting adjustment by providing an illness trajectory which cancer patients can use to prepare for their own cancer journey. Information from peers is prioritized by esophageal cancer patients, yet the content of this experiential information is not well understood. The purpose of this study is to understand the content of peer advice giving from posttreatment to newly diagnosed esophageal cancer patients. Esophageal cancer survivors (n = 23) at median 67-months postdiagnosis completed a single open-ended survey item which asked for advice they would give to individuals newly diagnosed with esophageal cancer on how to cope emotionally with the cancer journey (including adjusting to life after treatment). Transcripts were assessed using qualitative content analysis, with five categories of advice identified: social support, psychological approach, realistic expectations, support from healthcare professionals and self-care. The categories of advice reported were distinct from information needs prioritized by clinicians. This study demonstrates that experiential information is accessible and has the potential to identify neglected information and supportive care needs, and may have a potential use in delivery of psychological support to newly diagnosed patients.
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Affiliation(s)
- L Graham-Wisener
- Marie Curie Hospice Belfast, Marie Curie Cancer Care.,School of Psychology, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - M Dempster
- School of Psychology, Queen's University Belfast, Belfast, Northern Ireland, UK
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42
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Taioli E, Schwartz RM, Lieberman-Cribbin W, Moskowitz G, van Gerwen M, Flores R. Quality of Life after Open or Minimally Invasive Esophagectomy in Patients With Esophageal Cancer-A Systematic Review. Semin Thorac Cardiovasc Surg 2017; 29:377-390. [PMID: 28939239 DOI: 10.1053/j.semtcvs.2017.08.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2017] [Indexed: 02/08/2023]
Abstract
Although esophageal cancer is rare in the United States, 5-year survival and quality of life (QoL) are poor following esophageal cancer surgery. Although esophageal cancer has been surgically treated with esophagectomy through thoracotomy, an open procedure, minimally invasive surgical procedures have been recently introduced to decrease the risk of complications and improve QoL after surgery. The current study is a systematic review of the published literature to assess differences in QoL after traditional (open) or minimally invasive esophagectomy. We hypothesized that QoL is consistently better in patients treated with minimally invasive surgery than in those treated with a more traditional and invasive approach. Although global health, social function, and emotional function improved more commonly after minimally invasive surgery compared with open surgery, physical function and role function, as well as symptoms including choking, dysphagia, eating problems, and trouble swallowing saliva, declined for both surgery types. Cognitive function was equivocal across both groups. The potential small benefits in global and mental health status among those who experience minimally invasive surgery should be considered with caution given the possibility of publication and selection bias.
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Affiliation(s)
- Emanuela Taioli
- Department of Population Health Science and Policy, Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Rebecca M Schwartz
- Department of Population Health Science and Policy, Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Occupational Medicine, Epidemiology and Prevention, Northwell Health Hofstra Northwell School of Medicine, Great Neck, New York
| | - Wil Lieberman-Cribbin
- Department of Population Health Science and Policy, Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Gil Moskowitz
- Department of Population Health Science and Policy, Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Maaike van Gerwen
- Department of Population Health Science and Policy, Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Raja Flores
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
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43
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Scarpa M, Pinto E, Saraceni E, Cavallin F, Parotto M, Alfieri R, Nardi MT, Marchi MR, Cagol M, Castoro C. Randomized clinical trial of psychological support and sleep adjuvant measures for postoperative sleep disturbance in patients undergoing oesophagectomy. Br J Surg 2017; 104:1307-1314. [PMID: 28707741 DOI: 10.1002/bjs.10609] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 02/17/2017] [Accepted: 05/08/2017] [Indexed: 11/12/2022]
Abstract
BACKGROUND Major surgery such as oesophagectomy requires a postoperative stay in intensive care. Painful stimuli lead to sleep disturbance and impairment in quality of life. The aim of this study was to evaluate the effect of psychological counselling and sleep adjuvant measures on postoperative quality of sleep and quality of life. METHODS This RCT was performed between January 2013 and October 2015. Patients undergoing oesophagectomy for cancer were randomized into one of four groups receiving: psychological counselling plus sleep adjuvant measures during the ICU stay; psychological counselling alone; sleep adjuvant measures alone during the ICU stay; or standard care. The primary endpoint was impairment in quality of life measured using the European Organisation for Research and Treatment of Cancer C30-QL2 questionnaire between admission for surgery and discharge from hospital. The secondary endpoint was impairment in quality of sleep assessed by means of the Pittsburgh Sleep Quality Index between admission for surgery and hospital discharge. RESULTS The local ethics committee approved the early termination of the study because of relevant changes in the ICU setting. Some 87 patients were randomized and 74 patients were evaluated in the analysis. Psychological counselling reduced the impairment in quality of life (odds ratio 0·23, 95 per cent c.i. 0·09 to 0·61) and in quality of sleep (odds ratio 0·27, 0·10 to 0·73). CONCLUSION Perioperative psychological support reduces impairment in quality of life and quality of sleep after oesophagectomy. Registration number: NCT01738620 (http://www.clinicaltrials.gov).
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Affiliation(s)
- M Scarpa
- Oesophageal and Digestive Tract Surgical Unit, Regional Centre for Oesophageal Disease, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - E Pinto
- Oesophageal and Digestive Tract Surgical Unit, Regional Centre for Oesophageal Disease, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - E Saraceni
- Intensive Care Unit (ISTAR 2), Azienda Ospedaliera di Padova, Padua, Italy
| | - F Cavallin
- Oesophageal and Digestive Tract Surgical Unit, Regional Centre for Oesophageal Disease, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - M Parotto
- Intensive Care Unit, Toronto General Hospital, Toronto, Ontario, Canada
| | - R Alfieri
- Oesophageal and Digestive Tract Surgical Unit, Regional Centre for Oesophageal Disease, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - M T Nardi
- Nutritional Support Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - M R Marchi
- Respiratory Intensive Care Unit, Azienda Ospedaliera di Padova, Padua, Italy
| | - M Cagol
- Oesophageal and Digestive Tract Surgical Unit, Regional Centre for Oesophageal Disease, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - C Castoro
- Oesophageal and Digestive Tract Surgical Unit, Regional Centre for Oesophageal Disease, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
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Yibulayin W, Abulizi S, Lv H, Sun W. Minimally invasive oesophagectomy versus open esophagectomy for resectable esophageal cancer: a meta-analysis. World J Surg Oncol 2016; 14:304. [PMID: 27927246 PMCID: PMC5143462 DOI: 10.1186/s12957-016-1062-7] [Citation(s) in RCA: 151] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 11/23/2016] [Indexed: 12/11/2022] Open
Abstract
Background Open esophagectomy (OE) is associated with significant morbidity and mortality. Minimally invasive oesophagectomy (MIO) reduces complications in resectable esophageal cancer. The aim of this study is to explore the superiority of MIO in reducing complications and in-hospital mortality than OE. Methods MEDLINE, Embase, Science Citation Index, Wanfang, and Wiley Online Library were thoroughly searched. Odds ratio (OR)/weighted mean difference (WMD) with a 95% confidence interval (CI) was used to assess the strength of association. Results Fifty-seven studies containing 15,790 cases of resectable esophageal cancer were included. MIO had less intraoperative blood loss, short hospital stay, and high operative time (P < 0.05) than OE. MIO also had reduced incidence of total complications; (OR = 0.700, 95% CI = 0.626 ~ 0.781, PV < 0.05), pulmonary complications (OR = 0.527, 95% CI = 0431 ~ 0.645, PV < 0.05), cardiovascular complications (OR = 0.770, 95% CI = 0.681 ~ 0.872, PV < 0.05), and surgical technology related (STR) complications (OR = 0.639, 95% CI = 0.522 ~ 0.781, PV < 0.05), as well as lower in-hospital mortality (OR = 0.668, 95% CI = 0.539 ~ 0.827, PV < 0.05). However, the number of harvested lymph nodes, intensive care unit (ICU) stay, gastrointestinal complications, anastomotic leak (AL), and recurrent laryngeal nerve palsy (RLNP) had no significant difference. Conclusions MIO is superior to OE in terms of perioperative complications and in-hospital mortality.
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Affiliation(s)
- Waresijiang Yibulayin
- Department of Thoracic Surgery, Tumor Hospital of Xinjiang Medical University, Urumqi, China
| | - Sikandaer Abulizi
- Department of Thoracic Surgery, Tumor Hospital of Xinjiang Medical University, Urumqi, China
| | - Hongbo Lv
- Department of Thoracic Surgery, Tumor Hospital of Xinjiang Medical University, Urumqi, China
| | - Wei Sun
- Department of Thoracic Surgery, Tumor Hospital of Xinjiang Medical University, Urumqi, China.
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Prospective Study of Malabsorption and Malnutrition After Esophageal and Gastric Cancer Surgery. Ann Surg 2016; 262:803-7; discussion 807-8. [PMID: 26583669 DOI: 10.1097/sla.0000000000001445] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To study malabsorption and malnutrition after curative resection of esophageal and gastric cancer. DESIGN Prospective cohort study. BACKGROUND Improved cure rates for esophageal and gastric cancer have increased focus on health-related quality of life (HR-QL) in survivorship. Although malnutrition is well described in long-term follow-up, and gastrointestinal symptoms are common, data on gut and pancreatic-related malabsorption are scant. METHODS Disease-free patients at least 18 months after esophageal or gastric oncologic resections represented the study cohort. A modified Gastrointestinal Symptom Rating Scale questionnaire was completed, and weight, fecal elastase (FE), albumin, vitamins, and micronutrients measured preoperatively and at 1, 6, and 18 to 24 months postoperatively. Small intestinal bacterial overgrowth (SIBO) and changes in body composition were also evaluated postoperatively. RESULTS At a median follow-up of 23 months, 45 of 66 patients in a consecutive series were disease-free. Mean weight (78 ± 19 vs 67 ± 16 kg), body mass index (27 ± 5 vs 24 ± 5 kg/m), Vitamin A (1.7 ± 0.6 vs 1.2 ± 0.4 umol/L), and Vitamin E (28 ± 7 vs 20 ± 7 umol/L) were significantly decreased (P < 0.01) at last follow-up compared with preoperatively. Malabsorption was evident in 73% of patients, of whom 44% had FE < 200 μg/g and 38% had evidence of SIBO. Total body fat-free mass (175 ± 96 vs 84 ± 71, P < 0.001) and skeletal muscle index (44 ± 8 vs 39 ± 8, P = 0.007) were significantly decreased at 18 to 24 months. CONCLUSIONS Malabsorption and malnutrition are prevalent in survivorship of esophageal and stomach cancer. This may be underappreciated, and both gut and pancreatic insufficiency represent modifiable targets in the interdisciplinary approach to recovery of HR-QL.
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Ghaly G, Kamel M, Nasar A, Paul S, Lee PC, Port JL, Christos PJ, Stiles BM, Altorki NK. Locally advanced esophageal cancer: What becomes of 5-year survivors? J Thorac Cardiovasc Surg 2015; 151:726-732. [PMID: 26651958 DOI: 10.1016/j.jtcvs.2015.10.096] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 10/14/2015] [Accepted: 10/18/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To determine the long-term outcomes of patients with locally advanced esophageal cancer (LAEC) who underwent esophagectomy and survived at least 5 years, and the predictors of disease-free survival (DFS) beyond 5 years. METHODS This was a retrospective review of a prospective database to identify patients with clinical stage T2N0M0 or higher LAEC. Medical records were reviewed to obtain demographic, clinical, and pathological characteristics, as well as data on recurrence and survival. Multivariable analysis of predictors of DFS beyond 5 years was performed using a Cox regression model. RESULTS Between 1988 and 2009, 355 of 500 patients underwent esophagectomy for cT2N0M0 or higher disease. Of these 355 patients, 126 were alive and disease-free at the 5-year follow-up, for an actuarial 5-year DFS of 33%. Recurrent esophageal cancer developed in 8 patients after 5 years. Among the 126 surviving patients, the actuarial overall survival was 94% at 7 years and 80% at 10 years. On multivariable analysis, the sole significant predictor of DFS after the 5-year time point was non-en bloc resection at the original operation (P = .006). Pulmonary-related deaths accounted for 10 out of 22 noncancer deaths. A second primary cancer developed in 23 of the 126 surviving patients. CONCLUSIONS Prolonged survival can be obtained in one-third of patients with LAEC. An en bloc resection at the original operation is the most significant predictor of prolonged survival. Survivors experience a high rate of second primary cancer and an apparently high rate of deaths from pulmonary disease. Careful follow-up is necessary for these patients, even after the 5-year mark.
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Affiliation(s)
- Galal Ghaly
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, New York, NY
| | - Mohamed Kamel
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, New York, NY
| | - Abu Nasar
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, New York, NY
| | - Subroto Paul
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, New York, NY
| | - Paul C Lee
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, New York, NY
| | - Jeffrey L Port
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, New York, NY
| | - Paul J Christos
- Division of Biostatistics and Epidemiology, Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY
| | - Brendon M Stiles
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, New York, NY
| | - Nasser K Altorki
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, New York, NY.
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Cavallin F, Pinto E, Saadeh LM, Alfieri R, Cagol M, Castoro C, Scarpa M. Health related quality of life after oesophagectomy: elderly patients refer similar eating and swallowing difficulties than younger patients. BMC Cancer 2015; 15:640. [PMID: 26391127 PMCID: PMC4578681 DOI: 10.1186/s12885-015-1647-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 09/11/2015] [Indexed: 01/12/2023] Open
Abstract
Background Oesophagectomy for cancer could be safe and worthwhile in selected older patients, but less is known about the effect of oesophagectomy on perceived quality of life of such delicate class of cancer patients. The aim of this study was to evaluate the impact of oesophagectomy for cancer in elderly patients in term of health-related quality of life. Methods We retrospectively evaluated all consecutive patients who underwent oesophagectomy for cancer at the Surgical Oncology Unit of the Veneto Institute of Oncology between November 2009 and March 2014. Quality of life was evaluated using EORTC C-30 and OES-18 questionnaires at admission, at discharge and 3 months after surgery. Adjusted multivariable linear mixed effect models were estimated to assess mean score differences (MDs) of selected aspects in older (≥70 years) and younger (<70 years) patients. Results Among 109 participating patients, 23 (21.1 %) were at least 70 years old and 86 (78.9 %) were younger than 70 years. Global quality of life was clinically similar between older and younger patients over time (MD 4.4). Older patients reported clinically and statistically significantly worse swallowing saliva (MD 17.4, 95 % C.I. 3.6 to 31.2), choking when swallowing (MD 13.8, 95 % C.I. 5.8 to 21.8) and eating difficulties (MD 20.1 95 % C.I. 7.4 to 32.8) than younger patients only at admission. Conclusions Early health-related quality of life perception after surgery resulted comparable in older and younger patients. This result may also be due to some predisposition of the elderly to adapt to the new status. Electronic supplementary material The online version of this article (doi:10.1186/s12885-015-1647-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Francesco Cavallin
- Surgical Oncology Unit, Regional Centre for Oesophageal Disease, Veneto Institute of Oncology IOV IRCCS, Via Gattamelata 64, 35128, Padua, Italy.
| | - Eleonora Pinto
- Surgical Oncology Unit, Regional Centre for Oesophageal Disease, Veneto Institute of Oncology IOV IRCCS, Via Gattamelata 64, 35128, Padua, Italy.
| | - Luca M Saadeh
- Surgical Oncology Unit, Regional Centre for Oesophageal Disease, Veneto Institute of Oncology IOV IRCCS, Via Gattamelata 64, 35128, Padua, Italy.
| | - Rita Alfieri
- Surgical Oncology Unit, Regional Centre for Oesophageal Disease, Veneto Institute of Oncology IOV IRCCS, Via Gattamelata 64, 35128, Padua, Italy.
| | - Matteo Cagol
- Surgical Oncology Unit, Regional Centre for Oesophageal Disease, Veneto Institute of Oncology IOV IRCCS, Via Gattamelata 64, 35128, Padua, Italy.
| | - Carlo Castoro
- Surgical Oncology Unit, Regional Centre for Oesophageal Disease, Veneto Institute of Oncology IOV IRCCS, Via Gattamelata 64, 35128, Padua, Italy.
| | - Marco Scarpa
- Surgical Oncology Unit, Regional Centre for Oesophageal Disease, Veneto Institute of Oncology IOV IRCCS, Via Gattamelata 64, 35128, Padua, Italy.
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Abstract
A substantial portion of patients diagnosed preoperatively with high grade dysplasia (HGD) alone will have occult esophageal adenocarcinoma on analysis of the surgical specimen. Therefore, because of an increased risk of disease progression and malignancy, patients with HGD should be referred for esophagectomy promptly when endoscopic therapy has failed. The required extent of lymphadenectomy in this cohort of patients is unknown because of the variable incidence of submucosal cancer observed. Improvements in perioperative care, adoption of a minimally invasive surgical approach, and centralization of esophageal cancer services have substantially reduced the rates of mortality and morbidity associated with esophagectomy in recent years. Minimally invasive esophagectomy should be considered the treatment of choice in patients with dysplastic Barrett's esophagus that is refractory to endoscopic therapy or those at high risk of invasive cancer.
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Macefield RC, Jacobs M, Korfage IJ, Nicklin J, Whistance RN, Brookes ST, Sprangers MAG, Blazeby JM. Developing core outcomes sets: methods for identifying and including patient-reported outcomes (PROs). Trials 2014; 15:49. [PMID: 24495582 PMCID: PMC3916696 DOI: 10.1186/1745-6215-15-49] [Citation(s) in RCA: 122] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 01/17/2014] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Synthesis of patient-reported outcome (PRO) data is hindered by the range of available PRO measures (PROMs) composed of multiple scales and single items with differing terminology and content. The use of core outcome sets, an agreed minimum set of outcomes to be measured and reported in all trials of a specific condition, may improve this issue but methods to select core PRO domains from the many available PROMs are lacking. This study examines existing PROMs and describes methods to identify health domains to inform the development of a core outcome set, illustrated with an example. METHODS Systematic literature searches identified validated PROMs from studies evaluating radical treatment for oesophageal cancer. PROM scale/single item names were recorded verbatim and the frequency of similar names/scales documented. PROM contents (scale components/single items) were examined for conceptual meaning by an expert clinician and methodologist and categorised into health domains. A patient advocate independently checked this categorisation. RESULTS Searches identified 21 generic and disease-specific PROMs containing 116 scales and 32 single items with 94 different verbatim names. Identical names for scales were repeatedly used (for example, 'physical function' in six different measures) and others were similar (overlapping face validity) although component items were not always comparable. Based on methodological, clinical and patient expertise, 606 individual items were categorised into 32 health domains. CONCLUSION This study outlines a methodology for identifying candidate PRO domains from existing PROMs to inform a core outcome set to use in clinical trials.
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Affiliation(s)
- Rhiannon C Macefield
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - Marc Jacobs
- Department of Medical Psychology, Academic Medical Center/University of Amsterdam, Meibergdreef 5, Amsterdam NL 1105 AZ, Netherlands
| | - Ida J Korfage
- Department of Public Health, Erasmus MC, P.O. Box 2040, Rotterdam NL 3000 CA, Netherlands
| | - Joanna Nicklin
- Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Level 3, Dolphin House, Bristol Royal Infirmary, Marlborough Street, Bristol BS2 8HW, UK
| | - Robert N Whistance
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - Sara T Brookes
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - Mirjam AG Sprangers
- Department of Medical Psychology, Academic Medical Center/University of Amsterdam, Meibergdreef 5, Amsterdam NL 1105 AZ, Netherlands
| | - Jane M Blazeby
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
- Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Level 3, Dolphin House, Bristol Royal Infirmary, Marlborough Street, Bristol BS2 8HW, UK
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