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Färnqvist K, Mälberg K, Johar A, Schandl A, Lagergren P. Trajectories of patient-reported outcomes after oesophageal cancer surgery - A population-based study. Eur J Cancer 2024; 206:114133. [PMID: 38797039 DOI: 10.1016/j.ejca.2024.114133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 05/07/2024] [Accepted: 05/23/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND This study aimed to investigate the trajectories of patient-reported outcomes for individuals who have undergone surgery for oesophageal cancer over a five-year post-surgical period, and to identify modifiable factors that contribute to a decline in quality of life. METHODS Patients who underwent resection in Sweden between 2013 and 2020 were included. Data were collected at one-year post-surgery and at regular pre-determined intervals during the five-year post-surgical period. Latent class analysis and logistic regression models were used to identify symptom trajectories and determine their association with lifestyle factors, respectively. RESULTS This study included 408 patients, and the majority experienced consistent symptom burdens during the five-year post-surgery period. Current smokers had a higher risk of belonging to the severe dysphagia, severe eating restriction, and severe reflux trajectory. Physically active patients were less likely to belong to the severe dysphagia, severe eating restriction, and severe pain and discomfort trajectory. Patients with a stable weight were less likely to belong to the severe eating restriction and to the recovering body image trajectory. CONCLUSIONS Patients who are smokers, have a low level of physical activity, and experience weight loss need further attention and individual support to mitigate long-term symptom burden.
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Affiliation(s)
- Kenneth Färnqvist
- Surgical Care Science, Department of Molecular medicine and Surgery, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Kalle Mälberg
- Surgical Care Science, Department of Molecular medicine and Surgery, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Asif Johar
- Surgical Care Science, Department of Molecular medicine and Surgery, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Anna Schandl
- Surgical Care Science, Department of Molecular medicine and Surgery, Karolinska Institutet, 171 77 Stockholm, Sweden; Department of Anaesthesia and Intensive Care, Södersjukhuset, 118 83 Stockholm, Sweden; Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, 118 83 Stockholm, Sweden
| | - Pernilla Lagergren
- Surgical Care Science, Department of Molecular medicine and Surgery, Karolinska Institutet, 171 77 Stockholm, Sweden; Department of Surgery & Cancer, Imperial College London, United Kingdom.
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Lagergren P, Johar A, Mälberg K, Schandl A. Severe reflux, malnutrition and health-related quality of life after oesophageal cancer surgery: A prospective nationwide cohort study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108435. [PMID: 38820925 DOI: 10.1016/j.ejso.2024.108435] [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: 01/24/2024] [Revised: 04/12/2024] [Accepted: 05/22/2024] [Indexed: 06/02/2024]
Abstract
INTRODUCTION While most survivors of oesophageal cancer suffer from multiple symptoms, studies on combined symptom burden are scarce, particularly when looking at long-term outcomes. Therefore, we aimed to investigate the association between gastro-oesophageal reflux and health-related quality of life in malnourished survivors during the first years after oesophagectomy for cancer. MATERIALS AND METHODS This nationwide prospective cohort study included all Swedish patients who underwent curatively intended oesophagectomy for oesophageal cancer between 2013 and 2020 with 3-year follow-up. Linear mixed effect models were used to analyse the associations between reflux symptoms, malnutrition and HRQL at 1-, 2- and 3 years post-surgery and were presented with mean score difference (MSD) and 95 % confidence intervals (CI). RESULTS Among 406 included individuals, malnourished survivors with severe reflux reported more problems with nausea/vomiting (MSD 16.3, 95 % CI: 11.4 to 21.3), pain (MSD 16.5, 95 % CI: 10.2 to 22.8), body image (MSD 12.3, 95 % CI: 5.6 to 19.0), eating restrictions (MSD 11.3, 95 % CI: 6.1 to 16.5), swallowing saliva (MSD 10.0, 95 % CI: 5.2 to 14.8), dry mouth (MSD 10.5, 95 % CI: 2.4 to 18.7), and taste (MSD 14.1, 95 % CI: 7.1 to 21.0) compared to malnourished survivors with no reflux. Nausea/vomiting, financial difficulties, body image, and cognitive function were consistently worse for malnourished individuals with reflux throughout the 3 years. CONCLUSIONS The study suggests that gastro-oesophageal reflux negatively influences health-related quality of life in malnourished oesophageal cancer survivors. Nausea and/or vomiting were consistently worse for malnourished individuals with reflux independent of time point.
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Affiliation(s)
- Pernilla Lagergren
- Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; Department of Surgery and Cancer, Imperial College London, United Kingdom
| | - Asif Johar
- Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Kalle Mälberg
- Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Schandl
- Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; Department of Anaesthesiology and Intensive Care, Södersjukhuset, Stockholm, Sweden; Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
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Gao Z, Gao Z, Zheng C, Ma J, Zhao Y, Zhang L, Guo L. Reliability and validity of the cancer-related dysfunctional beliefs and attitudes about sleep scale in cancer patients. BMC Psychiatry 2024; 24:144. [PMID: 38378492 PMCID: PMC10880202 DOI: 10.1186/s12888-024-05580-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 02/03/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND Insomnia is a common health problem among cancer patients, which is not only a physical problem but also a psychological problem. Sleep plays an important role in the mental and somatic rehabilitation of cancer patients, and the sleep beliefs and attitudes of cancer patients are key factors in improving their sleep situation and quality of life. The aim of this study was to translate the Cancer-Related Dysfunctional Beliefs and Attitudes about Sleep (C-DBAS-14) scale into Chinese and to validate its reliability and validity in cancer patients. METHOD The C-DBAS-14 scale was translated into Chinese using the backward and forward translation procedure. The reliability of the scale was measured by internal consistency, split-half reliability and retest reliability. The validity of the scale was assessed through the content validity indicators, exploratory factor analysis and validation factor analysis. RESULT The Cronbach's ɑ coefficient of the Chinese version of the C-DBAS-14 was 0.932 while the McDonald's omega coefficient (ω t) was 0.934. The split-half reliability coefficient was 0.908, and the test-retest reliability was 0.857. The four-factor model was obtained using exploratory factor analysis, explaining 72.7% of the variance, with each item loading greater than 0.4 on the common factor. The results of the confirmatory factor analysis revealed that all indicators of model fit were within an acceptable range, indicating a well-fitting model. CONCLUSION The Chinese version of the C-DBAS-14 has good reliability and validity among cancer patients. It can be used to measure the sleep beliefs and attitudes of Chinese cancer patients.
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Affiliation(s)
- Ziyun Gao
- School of Nursing, Jinzhou Medical University, No.40, Section 3, Songpo Road, Linghe District, Jinzhou City, Liaoning Province, P.R. China
| | - Zihan Gao
- Shengjing Hospital affiliated to China Medical University, Shenyang City, Liaoning Province, P.R. China
| | - Chen Zheng
- School of Nursing, Jinzhou Medical University, No.40, Section 3, Songpo Road, Linghe District, Jinzhou City, Liaoning Province, P.R. China
| | - Jianing Ma
- College of Health Management, Liaoyang Vocational and Technical College, Liaoyang City, Liaoning Province, P.R. China
| | - Ying Zhao
- School of Nursing, Jinzhou Medical University, No.40, Section 3, Songpo Road, Linghe District, Jinzhou City, Liaoning Province, P.R. China
| | - Lin Zhang
- Department of Internal Medicine Nursing, School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, An Hui Province, P.R. China.
| | - Leilei Guo
- School of Nursing, Jinzhou Medical University, No.40, Section 3, Songpo Road, Linghe District, Jinzhou City, Liaoning Province, P.R. China.
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Li ZY, Ren JY, Zhong JD, Zhang JE. Understanding the supportive care needs among discharged patients with esophageal cancer after esophagectomy: A qualitative study. Eur J Oncol Nurs 2023; 64:102337. [PMID: 37290163 DOI: 10.1016/j.ejon.2023.102337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/26/2023] [Accepted: 04/29/2023] [Indexed: 06/10/2023]
Abstract
PURPOSE Patients with esophageal cancer experience physical and psychosocial difficulties after surgery. Understanding their unmet supportive care needs could help medical staff in providing high quality of care. This study aimed to gain insights into the supportive care needs of discharged patients with esophageal cancer after esophagectomy. METHOD A descriptive qualitative study design was used. A purposive sample of 20 patients was studied using semi-structured interviews. The thematic analysis approach was used to analyze the data. RESULTS Four themes and 14 sub-themes emerged from the analysis: (1) symptom management needs (dysphagia, reflux, fatigue, and other symptoms), (2) dietary and nutritional needs (unclear nutrition information, eating habit change, and dining out restriction), (3) psychosocial adjustment needs (stigma, dependency, fear of recurrence, and desire for normalcy), and (4) social support needs (medical staff support, family support, and peer support). CONCLUSION Chinese patients with esophageal cancer have various unmet supportive care needs after esophagectomy. Medical professionals should recognize patients' unmet supportive care needs in time, provide professional access and practical guidance, relieve their bad mood, and fully utilize online communicating channels, such as a consulting platform or a WeChat group, for further support.
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Affiliation(s)
- Zi Yun Li
- School of Nursing, Sun Yat-sen University, Zhongshan 2 Rd 74#, Guangzhou, Guangdong, PR China
| | - Jin Ying Ren
- School of Nursing, Sun Yat-sen University, Zhongshan 2 Rd 74#, Guangzhou, Guangdong, PR China
| | - Jiu Di Zhong
- Department of Thoracic Oncology, Cancer Center, Sun Yat-Sen University, Dongfeng 1 Rd 651#, Guangzhou, Guangdong, PR China
| | - Jun E Zhang
- School of Nursing, Sun Yat-sen University, Zhongshan 2 Rd 74#, Guangzhou, Guangdong, PR China.
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Hofmeister D, Schulte T, Mehnert-Theuerkauf A, Geue K, Zenger M, Esser P, Götze H, Hinz A. The association between sleep problems and general quality of life in cancer patients and in the general population. Front Psychol 2022; 13:960029. [PMID: 36591026 PMCID: PMC9800265 DOI: 10.3389/fpsyg.2022.960029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 11/23/2022] [Indexed: 12/23/2022] Open
Abstract
Objective It is well-known that patients with cancer frequently experience sleep problems, and that sleep quality is associated with general quality of life (QoL). The aims of this study were to analyze the relationship between sleep problems and other components of QoL in more detail and to investigate sex and age differences in sleep quality in cancer patients in comparison with the general population. Method This study comprised one general population sample (n = 4,476) and eight samples with cancer patients (n between 323 and 4,020). Sleep Quality was measured using the QoL questionnaire EORTC QLQ-C30. Results All of the cancer patient groups reported more sleep problems than the general population. Sleep problems were associated with all facets of QoL both in cancer patients and in the general population. The highest associations were found in cancer patients for fatigue (r = 0.52) and emotional functioning (r = -0.47). The association between sleep quality and general QoL was lower in the cancer samples (r = -0.37) than in the general population (r = -0.46). Female cancer patients reported markedly more sleep problems than male patients did (d = 0.45), while this sex difference was lower in the general population (d = 0.15). In contrast to the general population, younger cancer patients had greater trouble sleeping than older patients did (d = -0.17). Conclusion The results underline the significance of the role mental factors play in sleep problems. Health care providers should pay special attention to female patients and younger patients concerning this issue.
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Affiliation(s)
- Dirk Hofmeister
- Department of Medical Psychology and Medical Sociology, Leipzig University, Leipzig, Germany
| | - Thomas Schulte
- Rehabilitation Clinic Bad Oexen, Bad Oeynhausen, Germany
| | - Anja Mehnert-Theuerkauf
- Department of Medical Psychology and Medical Sociology, Leipzig University, Leipzig, Germany
| | - Kristina Geue
- Department of Medical Psychology and Medical Sociology, Leipzig University, Leipzig, Germany
| | - Markus Zenger
- Department of Applied Human Studies, University of Applied Sciences Magdeburg-Stendal, Stendal, Germany,Integrated Research and Treatment Center Adiposity Diseases, Leipzig University, Leipzig, Germany
| | - Peter Esser
- Department of Medical Psychology and Medical Sociology, Leipzig University, Leipzig, Germany
| | - Heide Götze
- Department of Medical Psychology and Medical Sociology, Leipzig University, Leipzig, Germany
| | - Andreas Hinz
- Department of Medical Psychology and Medical Sociology, Leipzig University, Leipzig, Germany,*Correspondence: Andreas Hinz,
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Sozzi M, Siboni S, Bonavina L. Sleeping on the Right Side After Esophagectomy. Clin Gastroenterol Hepatol 2022; 21:1377-1378. [PMID: 35552013 DOI: 10.1016/j.cgh.2022.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 04/26/2022] [Indexed: 02/07/2023]
Affiliation(s)
- Marco Sozzi
- Division of General and Foregut Surgery, IRCCS Policlinico San Donato, University of Milan Medical School, Milano, Italy
| | - Stefano Siboni
- Division of General and Foregut Surgery, IRCCS Policlinico San Donato, University of Milan Medical School, Milano, Italy
| | - Luigi Bonavina
- Division of General and Foregut Surgery, IRCCS Policlinico San Donato, University of Milan Medical School, Milano, Italy
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Schandl A, Mälberg K, Haglund L, Arnberg L, Lagergren P. Patient and public involvement in oesophageal cancer survivorship research. Acta Oncol 2022; 61:371-377. [PMID: 34923913 DOI: 10.1080/0284186x.2021.2016950] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Good clinical research is often conducted in close collaboration between patients, the public, and researchers. Few studies have reported the development of patient and public involvement (PPI) in research outside the United States and the United Kingdom, and for patients with more aggressive cancers. The study aimed to describe and evaluate the development of PPI in oesophageal cancer survivorship research in Sweden by the use of a framework to support the process. METHODS Oesophageal cancer survivors were recruited to a PPI research collaboration at Karolinska Institutet, Sweden. The development process was supported by the use of a framework for PPI, 'Patient and service user engagement in research'. Insights, benefits, and challenges of the process were described and discussed among the collaborators. RESULTS The collaboration resulted in joint publications with a more patient- and family-focussed perspective. It also contributed to the development of information folders about survivorship after oesophageal cancer surgery and national conference arrangements for patients, their families, healthcare workers, and researchers. Since the PPI contributors were represented in patient organisations and care programmes, the dissemination of research results increased. Their contributions were highly valued by the researchers, but also revealed some challenges. The use of a structured framework contributed to support and facilitated the process of establishing PPI in research collaboration. CONCLUSIONS A genuine interest in establishing PPI in research and an understanding and respect for the patients' expertise in providing a unique inside perspective was imperative for a successful collaboration. Research focus should not only be on mortality and reductions in daily life, but also on positive outcomes. Using a framework supports development and avoids pitfalls of PPI collaboration. PATIENT AND PUBLIC CONTRIBUTION Patient partners were equal collaborators in all aspects of the study.
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Affiliation(s)
- Anna Schandl
- Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Anaesthesiology and Intensive Care, Södersjukhuset, Stockholm, Sweden
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Kalle Mälberg
- Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Lena Haglund
- Surgical Care Science Patient Research Partnership Group, Karolinska Institutet, Stockholm, Sweden
| | - Lars Arnberg
- Surgical Care Science Patient Research Partnership Group, Karolinska Institutet, Stockholm, Sweden
| | - Pernilla Lagergren
- Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Surgery and Cancer, Imperial College, London, UK
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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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