Long-term quality of life in patients after total gastrectomy

Quality of life among cancer inpatients 80 years and older: a systematic review

Objective

The aim of this systematic review was to summarize and assess the literature on quality of life (QoL) among cancer patients 80 years and older admitted to hospitals and what QoL instruments have been used.

Methods

We searched systematically in Medline, Embase and Cinahl. Eligibility criteria included studies with any design measuring QoL among cancer patients 80 years and older hospitalized for treatment (surgery, chemotherapy or radiation therapy). Exclusion criteria: studies not available in English, French, German or Spanish. We screened the titles and abstracts according to a predefined set of inclusion criteria. All the included studies were assessed according to the Critical Appraisal Skills Programme checklists, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement checklist was used to ensure rigor in conducting and reporting. This systematic review was registered in PROSPERO (CRD42017058290).

Results

We included 17 studies with 2005 participants with various cancer diagnoses and Classification of Malignant Tumors stages (TNM). The included studies used a range of different QoL instruments and had different aims and outcomes. Both cancer-specific and generic instruments were used. Only one of the 17 studies used an age-specific instrument. All the studies included patients 80 years and older in their cohort, but none specifically analyzed QoL outcomes in this particular subgroup. Based on findings in the age-heterogeneous population (age range 20–100 years), QoL seems to be correlated with the type of diagnosed carcinoma, length of stay, depression and severe symptom burden.

Conclusion

We were unable to find any research directly exploring QoL and its determinants among cancer patients 80 years and older since none of the included studies presented specific analysis of data in this particular age subgroup. This finding represents a major gap in the knowledge base in this patient group. Based on this finding, we strongly recommend future studies that include this increasingly important and challenging patient group to use valid age- and diagnosis-specific QoL instruments.

[Patients with gastric cancer submitted to gastrectomy: an integrative review]

This study aims to analyze the scientific production about patients with gastric cancer submitted to gastrectomy and describe important aspects of nursing guidelines for these patients. An integrative review was carried out using Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) and Medical Literature Analysis and Retrieval System Online (MEDLINE) databases; twenty two articles were analyzed. Retrospective cross-sectional studies were the most frequent. The scientific production of nursing is numerically small in relation to the medical area. The results show that approaches related to pre and post-operative in gastrectomy for gastric cancer resection subsidize the knowledge of issues essential for nurses to promote efficient intervention for the recovery of such patients. There is still the need for further research on the practice of nursing in the guidelines of this kind of surgery.

Patients’ subjective symptoms, quality of life and intake of food during the recovery period 3 and 12 months after upper gastrointestinal surgery

Few studies describe patients' quality of life and their experienced symptoms during the recovery period after having undergone upper gastrointestinal surgery at 3 and 12 months. The aims of this study were to explore patients' quality of life and symptoms preoperatively and at 3 and 12 months following upper gastrointestinal surgery and to describe and compare patients' experiences of appetite, food intake, weight changes, tiredness and sleeping patterns. A descriptive and comparative quantitative design was used. Three instruments were used: the Gastrointestinal Symptom Rating Scale, the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire and the Eating Dysfunction Scale. A questionnaire was used to investigate symptoms such as mood, appetite, sleep, activities and well-being. Twenty-four patients were included in the study. The major results were that anxiety levels and global health status decreased and that patients felt more disappointed after 12 months compared with after 3 months. Four patients at 3 months after surgery and eight patients at 12 months regained their weight compared with the situation before surgery. The contribution of nursing care activities focusing on the importance of food intake and the patients' current and historical medical records in relation to their health status should continue to be examined and researched over a longer period of time.

Quality of life after total or partial gastrectomy for primary gastric lymphoma

Up to 90% of patients with localized non-Hodgkin's lymphomas (NHL) in the gastrointestinal tract (GI) are cured and decreased use of radical surgery is favoured. Although quality of life (QOL) may impact treatment choice, little is known about QOL in gastric NHL survivors. The self-reported QOL (EORTC QLQ-C30 and a gastric module) and objective findings from upper GI endoscopy were evaluated in patients in complete remission after treatment for primary gastric NHL at the Norwegian Radium Hospital (NRH). Thirty-six (90%) patients completed the questionnaires, 33 (83%) met for endoscopy. Ten patients were treated with total gastrectomy, 17 with partial gastrectomy, while nine patients did not undergo surgery. Gastroscopy was normal in 55% of the non-gastrectomised patients, oesophagoscopy in 69%. Four patients had Barrett's metaplasia. QOL was not different from population values. Patients treated with total gastrectomy reported poorer emotional function, more diarrhoea and more food-related problems (p< or =0.05) compared with the others. Based on the higher level of digestive and food related problems after total gastrectomy, stomach-preserving surgery should be preferred whenever possible.

Pilot Study on Gastric Electrical Stimulation on Surgery-associated Gastroparesis: Long-term Outcome

OBJECTIVES

Patients with postgastric surgery gastroparesis are often unresponsive to conventional medical therapy. Gastric electrical stimulation (GES) with the use of high-frequency and low-energy neural stimulation is an approved technique for patients with idiopathic and diabetic gastroparesis.

METHODS

We hypothesized that GES would improve symptoms, health resource utilization, and gastric emptying in six patients with postsurgical gastroparesis from a variety of surgical procedures. Patients were evaluated by means of the following criteria: symptoms, health-related quality of life, and gastric emptying tests at baseline over time.

RESULTS

All patients noted improvements after device implantation for up to 46 months: the frequency score for weekly vomiting went from a baseline of 3.2 down to 0.4 immediately after treatment before settling at 1.4 by the long-term follow up. Total gastrointestinal symptom score went from 36.5 at baseline down to 12.3 before settling at 20.5 at long-term follow up. Improvements were also seen in health-related quality of life and solid and liquid gastric emptying.

CONCLUSIONS

We conclude that GES is associated with clinical improvements in this group of patients with either postsurgical or surgery-associated gastroparesis. This pilot study with long-term outcomes offers evidence for a new therapy for otherwise refractory patients with gastroparesis associated with previous surgery.

Quality of life in gastric cancer

AIM: To summarize the empirical research on assessing quality of life (QOL) in patients with gastric carcinoma.

METHODS: Literature searches were conducted in MedLine from 1966 to February 2004.

RESULTS: Twenty-six studies were identified. QOL was used as an outcome measure in virtually all identified studies, such as those examining the effects of gastric cancer and various medical or surgical treatments in the patients. QOL was assessed mainly with generic measures; the social dimensions of QOL were largely neglected. The lack of gastric cancer-specific QOL measures hampers QOL research up to now. The gastric cancer-specific EORTC-QLQ-STO22 and the FACT-Ga are important additions to the arsenal of disease-specific QOL measures. In most of the studies, the label QOL is used for questionnaires, which only assess symptoms or performance status, or are physician-reported rather than patient-reported outcomes.

CONCLUSION: QOL in patients with gastric cancer deserves more systematic studies, especially as one of the outcome measures in randomized clinical trials. Results of studies that include QOL in patients with gastric cancer should be applied in clinical care, which aims at improving QOL of these patients.

Postoperative quality of life among patients with thyroid cancer

BACKGROUND

Thyroid cancer patients have a survival rate of over 90% after thyroidectomy. However, quality of life with a generic focus has rarely been studied in thyroid cancer survivors.

AIM

This paper reports a study to examine and describe factors associated with quality of life among patients with thyroid cancer after operation.

METHODS

Adult patients who had a thyroidectomy for cancer between January 1999 and June 2001 in a Taiwan city participated in the study. Telephone interviews was completed with 146 (67%) of those 218 eligible, asking about sociodemographic variables, disease/treatment characteristics and social support. Quality of life was measured by the Chinese version of the Quality of Life Index. Multivariate analyses were performed using multiple linear regressions.

RESULT

The regression model showed that patients at 19-36 months after operation had lower quality of life compared with those within 18 months of operation. Current symptoms of fatigue and chills were negatively associated with quality of life. Those who rated the impact of operational scar on activities as 'high' had lower quality of life scores. Social support from families and friends had positive effects on quality of life. The model r2 was 48.1%.

CONCLUSIONS

Nurses could improve quality of life among patients with thyroid cancer by strengthening their social support and educating them in self-management of uncomfortable symptoms. Surgeons should consider types of operation in which the scar would be less likely to influence the patients' activities.

Symptoms, Psychological Distress, Social Support, and Quality of Life of Chinese Patients Newly Diagnosed With Gastrointestinal Cancer

This study aims to describe symptoms, psychological distress, social support, and quality of life of Chinese patients newly diagnosed with gastrointestinal tract (GIT) cancer, and to identify the extent to which demographic, physical, and psychosocial factors predict their quality of life. A convenience sample of 146 newly diagnosed GIT cancer patients recruited from 3 major hospitals in Shanghai completed a self-report questionnaire. The questionnaire was designed to obtain demographic and medical data and measures of symptoms, psychological distress, social support, health-related quality of life (HRQoL), and global quality of life (GQoL). Measures developed in English were translated into Chinese using the procedure advocated by WHO. The results showed that the most common signs and symptoms reported were fatigue, pain, and weight loss; 28% of the patients were depressed; and overall, patients had a moderate quality of life. Comparative analyses found some difference on measures for demographic and diagnostic subgroups. Depression, symptom distress, and social support accounted for 44% of the total variance for HRQoL, while perceived financial difficulty and symptom distress accounted for 20% of the total variance for GQoL. Findings from this research give insights into the importance of quality of life assessment, symptom management, and intervention to improve the quality of life of Chinese cancer patients. It also raises questions about measures of quality of life that are culturally relevant.

[Nutritional status and dietary assessment of patients with gastrectomy]

BACKGROUND

Nutrition is a crucial factor in gastric resection surgery and the most suitable alimentary canal reconstruction method must be considered in order to reduce the risk of malnutrition. The cause of postgastrectomy malnutrition has not been clearly determined, but the mechanisms behind malnutrition are evidently multifactorial.

AIM

To evaluate the nutritional status of patients who underwent different reconstructive procedures after total or subtotal gastrectomy.

PATIENTS AND METHODS

Fifty patients who have undergone gastrectomy for 0.5-39 years were assessed. The surgical procedures used were Billroth I in 7, Billroth II in 26, Henley in 3 and Roux-en-Y in 14 of the patients. Twenty one of them have followed gastrectomy for cancer. The nutritional status was evaluated by subjective global assessment, dietary recall and anthropometry.

RESULTS

According to subjective global assessment, 6 of 50 patients were mild malnourished. The mean body mass index was 22 4.75 kg/m2, the average daily calorie intake was 1624 477 Kcal. Of the patients operated for cancer, those who underwent subtotal gastrectomy followed by Roux-en-Y presented higher body mass index. No relationship between the period of time since surgery with body mass index or with calorie intake was found.

CONCLUSIONS

Among patients operated for cancer, subtotal gastrectomy with Roux-en-Y reconstruction is associated with better nutritional status. Factors other than low calorie intake are the cause of weight loss in patients with gastrectomy.