1
|
Gabada R, Athawale V. Comprehensive Rehabilitation Strategies in Esophageal Cancer: A Case Report of Enhancing Recovery and Quality of Life. Cureus 2024; 16:e57893. [PMID: 38725790 PMCID: PMC11079694 DOI: 10.7759/cureus.57893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 04/09/2024] [Indexed: 05/12/2024] Open
Abstract
Esophageal cancer is a significant global health burden; it is the seventh most commonly diagnosed cancer and the sixth leading cause of cancer-related deaths globally. It accounts for 3.2% of newly diagnosed malignancies; adenocarcinoma and squamous cell carcinoma are the most prevalent histological subtypes. Clinical presentation often includes dysphagia, odynophagia, weight loss, and persistent heartburn. Diagnosis is confirmed through endoscopy and imaging studies, with treatment typically involving chemotherapy, surgery, and/or radiation therapy. Physiotherapy plays a crucial role in managing pulmonary complications and improving overall cardiopulmonary function in these patients. We present the case of a 70-year-old woman with esophageal cancer, detailing her symptoms, diagnostic assessment, therapeutic interventions, and outcomes, highlighting the importance of a multidisciplinary approach in managing this challenging condition.
Collapse
Affiliation(s)
- Rishika Gabada
- Oncology Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Vrushali Athawale
- Oncology Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| |
Collapse
|
2
|
Zhai T, Huang R, Zhan Y, Xu L, Yu Y, Guo L, Chen J, Su C, Chen C. Radiotherapy for patients with esophageal cancer aged 80 years or older: A 16-year experience. J Cancer Res Ther 2024; 20:678-683. [PMID: 38687940 DOI: 10.4103/jcrt.jcrt_833_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 11/29/2023] [Indexed: 05/02/2024]
Abstract
PURPOSE Radiotherapy (RT) plays an important role in esophageal cancer (EC) patients aged ≥80 years. However, the survival modality and prognostic factors remain poorly understood. Thus, this study aimed to evaluate the tolerance and long-term overall survival (OS) of patients aged ≥80 years who were diagnosed with EC and underwent definitive RT. MATERIALS AND METHODS A total of 213 consecutive patients with EC over 80 years old who were treated with curative intent RT between February 1999 and December 2015 at our institution were retrospectively reviewed. The clinical prognostic variables were analyzed against OS in univariate analyses using log-rank tests and in a multivariate model using Cox regression proportional hazards analysis. RESULT The median patient age was 82 (range: 80-94) years. Atotal of 192 patients (90.1%) completed the definitive RT (median: 60 Gy, range: 50-72 Gy), and 11 patients had grade 4 or higher acute toxicity, including esophagitis, a cardiac event, infections, and sudden death. Atotal of 168 deaths (78.9%) were observed with a median follow up of 47 months (range: 0-153 months). The OS rates were 50.3%, 17.6%, and 13.2% at 1, 3, and 5 years, respectively. Multivariable analysis identified that tumors located in the cervical and upper thorax, a shorter tumor lesion, RT treatment of 50-60Gy, and a better response to treatment were the factors associated with longer OS. CONCLUSION Definitive RT could be considered as an effective treatment for patients with EC who are older than 80 years, and 50-60 Gy seems to be a reasonable dose for these patients.
Collapse
Affiliation(s)
- Tiantian Zhai
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Pang Q, Duan L, Jiang Y, Liu H. Oncologic and long-term outcomes of enhanced recovery after surgery in cancer surgeries - a systematic review. World J Surg Oncol 2021; 19:191. [PMID: 34187485 PMCID: PMC8243430 DOI: 10.1186/s12957-021-02306-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 06/17/2021] [Indexed: 12/21/2022] Open
Abstract
Background Clinical evidence has proved that enhanced recovery after surgery (ERAS) can improve short-term clinical outcomes after various types of surgeries, but the long-term benefits have not yet been examined, especially with respect to cancer surgeries. Therefore, a systematic review of the current evidence was conducted. Methods The Pubmed, Cochrane Library, Embase, and Web of Science databases were searched using the following key words as search terms: “ERAS” or “enhanced recovery” or “fast track”, “oncologic outcome”, “recurrence”, “metastasis”, “long-term outcomes”, “survival”, and “cancer surgery”. The articles were screened using the inclusion and exclusion criteria, and the data from the included studies were extracted and analyzed. Results A total of twenty-six articles were included in this review. Eighteen articles compared ERAS and conventional care, of which, 12 studies reported long-term overall survival (OS), and only 4 found the improvement by ERAS. Four studies reported disease-free survival (DFS), and only 1 found the improvement by ERAS. Five studies reported the outcomes of return to intended oncologic treatment after surgery (RIOT), and 4 found improvements in the ERAS group. Seven studies compared high adherence to ERAS with low adherence, of which, 6 reported the long-term OS, and 3 showed improvements by high adherence. One study reported high adherence could reduce the interval from surgery to RIOT. Four studies reported the effect of altering one single item within the ERAS protocol, but the results of 2 studies were controversial regarding the long-term OS between laparoscopic and open surgery, and 1 study showed improvements in OS with restrictive fluid therapy. Conclusions The use of ERAS in cancer surgeries can improve the on-time initiation and completion of adjuvant chemotherapy after surgery, and the high adherence to ERAS can lead to better outcomes than low adherence. Based on the current evidence, it is difficult to determine whether the ERAS protocol is associated with long-term overall survival or cancer-specific survival. Supplementary Information The online version contains supplementary material available at 10.1186/s12957-021-02306-2.
Collapse
Affiliation(s)
- Qianyun Pang
- Department of Anesthesiology, Chongqing University Cancer Hospital, Hanyu Road No. 181, Shapingba District, Chongqing, 400030, China
| | - Liping Duan
- Department of Anesthesiology, Chongqing University Cancer Hospital, Hanyu Road No. 181, Shapingba District, Chongqing, 400030, China
| | - Yan Jiang
- Department of Anesthesiology, Chongqing University Cancer Hospital, Hanyu Road No. 181, Shapingba District, Chongqing, 400030, China
| | - Hongliang Liu
- Department of Anesthesiology, Chongqing University Cancer Hospital, Hanyu Road No. 181, Shapingba District, Chongqing, 400030, China.
| |
Collapse
|
4
|
O'Connell L, Coleman M, Kharyntiuk N, Walsh TN. Quality of life in patients with upper GI malignancies managed by a strategy of chemoradiotherapy alone versus surgery. Surg Oncol 2019; 30:33-39. [PMID: 31500782 DOI: 10.1016/j.suronc.2019.05.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 04/09/2019] [Accepted: 05/25/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND OBJECTIVES Neoadjuvant chemoradiotherapy (nCRT) induces a pathological complete response (pCR) in 25-85% of oesophago-gastric cancer. As surgery entails morbidity and mortality risks and quality of life (QL) impairment, its avoidance in patients without residual disease is desirable. This study aimed to compare quality of life of patients with a cCR who chose surveillance with those who chose surgery. METHODS Four groups of patients were studied. Group 1(n = 31) were controls; Group 2 (n = 26) had chemoradiotherapy only; Group 3 (n = 31) had oesophagectomy after nCRT; Group 4 (n = 26) had gastrectomy alone. A 33-point novel questionnaire was administered at two 3 month time points. Participants were also interviewed with a validated questionnaire. RESULTS Mean(±sd) quality of life scores in cCR patients offered surveillance (28.9 ± 4.5) were superior to patients undergoing oesophagectomy (32.3 ± 58. p=0.042) or gastrectomy (33.19 ± 5.9, p=0.004). This result was replicated in the validated questionnaire (p=0.017). There was a trend towards increased reflux-related respiratory symptoms in the oesophagectomy group (7.3 ± 2.2 vs 6.5 ± 1.9; p=0.396) and towards early dumping (8.2 ± 1.4 vs 7.1 ± 1.; p=0.239) and vagotomy-related symptoms (1.82 ± 0.9 vs 1.4 ± 0.6; p=0.438) in the gastrectomy group. CONCLUSIONS Avoidance of surgery in cCR patients is rewarded with a superior quality of life to those undergoing surgery.
Collapse
Affiliation(s)
- Lauren O'Connell
- Royal College of Surgeons in Ireland, Department of Surgery, Connolly Hospital, Blanchardstown, Dublin 15, Ireland.
| | - Mary Coleman
- Royal College of Surgeons in Ireland, Department of Surgery, Connolly Hospital, Blanchardstown, Dublin 15, Ireland
| | - N Kharyntiuk
- Royal College of Surgeons in Ireland, Department of Surgery, Connolly Hospital, Blanchardstown, Dublin 15, Ireland
| | - Thomas N Walsh
- Royal College of Surgeons in Ireland, Department of Surgery, Connolly Hospital, Blanchardstown, Dublin 15, Ireland; Royal College of Surgeons in Ireland, Department of Surgery, Beaumont Hospital, Dublin 9, Ireland
| |
Collapse
|
5
|
Ji HB, Chen QP, Zhang F, Zhu WT, Zhao BL, Wei Q, Sun BF, Yang Z, Wang XX. Impact of enhanced recovery after surgery programs on long-term survival among patients undergoing digestive tract tumor surgery: A meta-analysis. Shijie Huaren Xiaohua Zazhi 2019; 27:442-449. [DOI: 10.11569/wcjd.v27.i7.442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Enhanced recovery after surgery (ERAS) programs refer to a series of optimization measures based on evidence-based medical evidence to reduce perioperative stress response and speed up the recovery of organ function after surgery through a multi-disciplinary collaboration model. ERAS has been popularized in many disciplines and proved to improve the short-term prognosis of patients, while the study of long-term prognosis of patients is limited.
AIM To evaluate the impact of ERAS programs on the long-term survival among patients undergoing digestive tract tumor surgery.
METHODS Computer searches were performed in databases including Wanfang, CNKI, VIP, PubMed, Cochrane Library, and EMBASE for randomized controlled trials or case-control studies describing ERAS programs in patients undergoing digestive tract tumor surgery published between January 1995 and November 2018. Two researchers independently evaluated the quality of studies that met the inclusion criteria and performed a meta-analysis using RevMan5.3.5 software.
RESULTS A total of ten studies including 2477 patients were selected for the meta-analysis, including the ERAS group (n = 751) and the control group (n = 1726, undergoing traditional perioperative management). Compared with the control group, the ERAS group had improved 3-year survival (OR = 0.48, 95%CI: 0.30-0.78, P < 0.05) and 5-year survival (OR = 0.51, 95%CI: 0.40-0.65, P < 0.05). However, no significant difference was observed in 1-year survival (OR = 1.13, 95%CI: 0.63-2.02, P > 0.05) or 2-year survival (OR = 1.19, 95%CI: 0.38-3.73, P > 0.05) between the two groups.
CONCLUSION Perioperative implementation of ERAS programs can improve outcomes and 3- and 5-year survival among patients undergoing digestive tract tumor surgery.
Collapse
Affiliation(s)
- Hai-Bin Ji
- Department of Hepatobiliary Surgery, Binzhou Medical University Hospital, Binzhou 256603, Shandong Province, China
| | - Qiang-Pu Chen
- Department of Hepatobiliary Surgery, Binzhou Medical University Hospital, Binzhou 256603, Shandong Province, China
| | - Fan Zhang
- Department of Hepatobiliary Surgery, Binzhou Medical University Hospital, Binzhou 256603, Shandong Province, China
| | - Wen-Tao Zhu
- Department of Hepatobiliary Surgery, Binzhou Medical University Hospital, Binzhou 256603, Shandong Province, China
| | - Bao-Lei Zhao
- Department of Hepatobiliary Surgery, Binzhou Medical University Hospital, Binzhou 256603, Shandong Province, China
| | - Qiang Wei
- Department of Hepatobiliary Surgery, Binzhou Medical University Hospital, Binzhou 256603, Shandong Province, China
| | - Bao-Fang Sun
- Department of Hepatobiliary Surgery, Binzhou Medical University Hospital, Binzhou 256603, Shandong Province, China
| | - Zhen Yang
- Department of Hepatobiliary Surgery, Binzhou Medical University Hospital, Binzhou 256603, Shandong Province, China
| | - Xiao-Xiao Wang
- Department of Hepatobiliary Surgery, Binzhou Medical University Hospital, Binzhou 256603, Shandong Province, China
| |
Collapse
|
6
|
Jamel S, Tukanova K, Markar SR. The evolution of fast track protocols after oesophagectomy. J Thorac Dis 2019; 11:S675-S684. [PMID: 31080644 DOI: 10.21037/jtd.2018.11.63] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Fast track is a standardised goal directed patient's care pathway that aims to facilitate recovery following surgery. Currently, there are large variations in the fast track protocols used in oesophagectomy due to the complexity of the procedure. The objective of this systematic review is to assess the evolution of fast track protocols following oesophagectomy since its implementation and the resulting effect on postoperative outcomes. Relevant electronic databases were searched for studies assessing the clinical outcome from fast track in oesophagectomy and also those assessing the effects of the individual key components in fast track protocols. The search yielded twenty-three publications regarding fast track implementation in oesophagectomy. A pattern of consistent evolution in fast-track protocols was clearly demonstrated and these have shown variations in the core-identified components across the studies. However, evolution in fast track protocols over time showed, an overall improvement in length of stay, anastomotic leak, pulmonary complications and mortality over time. Thirty publications were included that evaluated specific components of fast track protocols, with an increasing trend towards addressing the nutritional aspect in oesophagectomy care in more recent years. The variations in the key components of fast track protocol of care identify the need for continued assessment and identification for areas of improvement. In the future incremental gains through focused improvements in key components will lend itself to even better postoperative outcomes and patient experience during oesophageal cancer treatment.
Collapse
Affiliation(s)
- Sara Jamel
- Department Surgery & Cancer, Imperial College London, London, UK
| | - Karina Tukanova
- Department Surgery & Cancer, Imperial College London, London, UK
| | - Sheraz R Markar
- Department Surgery & Cancer, Imperial College London, London, UK
| |
Collapse
|
7
|
Neuwirth MG, Bierema C, Sinnamon AJ, Fraker DL, Kelz RR, Roses RE, Karakousis GC. Trends in major upper abdominal surgery for cancer in octogenarians: Has there been a change in patient selection? Cancer 2017; 124:125-135. [DOI: 10.1002/cncr.30977] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 07/07/2017] [Accepted: 07/24/2017] [Indexed: 12/28/2022]
Affiliation(s)
- Madalyn G. Neuwirth
- Department of Surgery; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania
| | - Christine Bierema
- Department of Surgery; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania
| | - Andrew J. Sinnamon
- Department of Surgery; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania
| | - Douglas L. Fraker
- Department of Surgery; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania
| | - Rachel R. Kelz
- Department of Surgery; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania
| | - Robert E. Roses
- Department of Surgery; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania
| | - Giorgos C. Karakousis
- Department of Surgery; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania
| |
Collapse
|
8
|
Bollschweiler E, Plum P, Mönig SP, Hölscher AH. Current and future treatment options for esophageal cancer in the elderly. Expert Opin Pharmacother 2017; 18:1001-1010. [DOI: 10.1080/14656566.2017.1334764] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Elfriede Bollschweiler
- Department of General, Visceral and Cancer Surgery, University of Cologne, Köln, Germany
| | - Patrick Plum
- Department of General, Visceral and Cancer Surgery, University of Cologne, Köln, Germany
| | - Stefan P. Mönig
- Department of General, Visceral and Cancer Surgery, University of Cologne, Köln, Germany
- Service de Chirurgie viscéral, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Arnulf H. Hölscher
- Department of General, Visceral and Cancer Surgery, University of Cologne, Köln, Germany
- Department of Surgery, AGAPLESION Markus Krankenhaus, Frankfurt, Germany
| |
Collapse
|