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Zang Y, Qiu Y, Sun Y, Fan Y. Baseline functioning scales of EORTC QLQ-C30 predict overall survival in patients with gastrointestinal cancer: a meta-analysis. Qual Life Res 2024; 33:1455-1468. [PMID: 38227073 DOI: 10.1007/s11136-023-03591-y] [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] [Accepted: 12/19/2023] [Indexed: 01/17/2024]
Abstract
PURPOSE A consensus has not been reached on the value of quality of life (QoL) as a prognostic factor for survival in gastrointestinal cancer. This meta-analysis aimed to investigate the association between functioning scales of the EORTC QoL Questionnaire Core 30 (QLQ-C30) and the overall survival (OS) in patients with gastrointestinal cancer. METHODS A systematic literature search was conducted in PubMed, Web of Science, and Embase databases, until February 7, 2023. The studies included were those that investigated the association between baseline QoL measured by the functioning scales of EORTC QLQ-C30 and OS in patients with gastrointestinal cancer. The prognostic capacity of QoL was calculated by pooling the adjusted hazard ratios (HR) with 95% confidence intervals (CI). RESULTS Twenty-four studies' analyses reported by 22 eligible articles involving 11,609 patients were included. When compared with good parameters of QoL, poor global QoL (HR 1.81; 95% CI 1.53-2.13), physical functioning (HR 1.51; 95% CI 1.31-1.74), social functioning (HR 1.67; 95% CI 1.30-2.15), and role functioning scale (HR 1.42; 95% CI 1.20-1.29) were significantly associated with decreased OS. For each 10-point increase in QLQ-C30 parameters, the pooled HR of OS was 0.87 (95% CI 0.83-0.92) for global QoL, 0.87 (95% CI 0.83-0.92) for physical functioning, and 0.93 (95% CI 0.88-0.97) for role functioning. However, each 10-point increase in social, emotional, or cognitive functioning scale did not significantly predict OS. CONCLUSIONS Baseline health-related QoL defined by the physical functioning or global QoL scale of EORTC QLQ-C30 significantly predicts OS in patients with gastrointestinal cancer.
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Affiliation(s)
- Ye Zang
- Department of Oncology, The People's Hospital of Danyang, Affiliated Danyang Hospital of Nantong University, Danyang, 212399, China
| | - Yue Qiu
- Cancer Institute, The Affiliated People's Hospital, Jiangsu University, Zhenjiang, 212002, China
| | - Yimeng Sun
- Cancer Institute, The Affiliated People's Hospital, Jiangsu University, Zhenjiang, 212002, China.
- Institute of Molecular Biology & Translational Medicine, The Affiliated People's Hospital, Jiangsu University, No. 8 Dianli Road, Zhenjiang, 212002, Jiangsu, China.
| | - Yu Fan
- Cancer Institute, The Affiliated People's Hospital, Jiangsu University, Zhenjiang, 212002, China.
- Institute of Molecular Biology & Translational Medicine, The Affiliated People's Hospital, Jiangsu University, No. 8 Dianli Road, Zhenjiang, 212002, Jiangsu, China.
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Jeon CH, Park KB, Kim S, Seo HS, Song KY, Lee HH. Predictive model for long-term weight recovery after gastrectomy for gastric cancer: an introduction to a web calculator. BMC Cancer 2023; 23:580. [PMID: 37353748 DOI: 10.1186/s12885-023-11050-7] [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: 02/15/2023] [Accepted: 06/08/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND Weight changes after gastrectomy affect not only quality of life but also prognosis and survival. However, it remains challenging to predict the weight changes of individual patients. Using clinicopathological variables, we built a user-friendly tool to predict weight change after curative gastrectomy for gastric cancer. METHODS The clinical data of 984 patients who underwent curative gastrectomy between 2009 and 2013 were retrospectively reviewed and analyzed. Multivariate logistic regression was performed to identify variables predictive of postoperative weight change. A nomogram was developed and verified via bootstrap resampling. RESULTS Age, sex, performance status, body mass index, extent of resection, pathological stage, and postoperative weight change significantly influenced postoperative weight recovery. Postoperative levels of hemoglobin, albumin, ferritin and total iron-binding capacity were significant covariates. The nomogram performed well (concordance index = 0.637); calibration curves indicated appropriate levels of agreement. We developed an online weight prediction calculator based on the nomogram ( http://gc-weightchange.com/en/front/ ). CONCLUSIONS The novel, Web-calculator based on the predictive model allows surgeons to explore patient weight patterns quickly. The model identifies patients at high risk for weight loss after gastrectomy; such patients require multidisciplinary medical support.
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Affiliation(s)
- Chul-Hyo Jeon
- Department of Surgery, Division of Gastrointestinal Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 271, Cheonbo-ro, Uijeongbu-si, Gyeonggi-do, 11765, Republic of Korea
| | - Ki Bum Park
- Department of Surgery, Division of Gastrointestinal Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, 93, Jungbu-daero, Paldal-gu, Suwon-si, Gyeonggi-do, 16247, Republic of Korea
| | - Sojung Kim
- Department of Surgery, Division of Gastrointestinal Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-Daero, Seocho-Gu, Seoul, 06591, Republic of Korea
| | - Ho Seok Seo
- Department of Surgery, Division of Gastrointestinal Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-Daero, Seocho-Gu, Seoul, 06591, Republic of Korea
| | - Kyo Young Song
- Department of Surgery, Division of Gastrointestinal Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-Daero, Seocho-Gu, Seoul, 06591, Republic of Korea
| | - Han Hong Lee
- Department of Surgery, Division of Gastrointestinal Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-Daero, Seocho-Gu, Seoul, 06591, Republic of Korea.
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Junttila A, Helminen O, Helmiö M, Huhta H, Kallio R, Koivukangas V, Kokkola A, Laine S, Lietzen E, Meriläinen S, Pohjanen VM, Rantanen T, Ristimäki A, Räsänen JV, Saarnio J, Sihvo E, Toikkanen V, Tyrväinen T, Valtola A, Kauppila JH. Long-Term Survival After Transhiatal Versus Transthoracic Esophagectomy: A Population-Based Nationwide Study in Finland. Ann Surg Oncol 2022; 29:8158-8167. [PMID: 36006492 PMCID: PMC9640399 DOI: 10.1245/s10434-022-12349-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 07/12/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND No population-based studies comparing long-term survival after transhiatal esophagectomy (THE) and transthoracic esophagectomy (TTE) exist. This study aimed to compare the 5-year survival of esophageal cancer patients undergoing THE or TTE in a population-based nationwide setting. METHODS This study included all curatively intended THE and TTE for esophageal cancer in Finland during 1987-2016, with follow-up evaluation until 31 December 2019. Cox proportional hazard models provided hazard ratios (HRs) with 95% confidence intervals (CIs) of 5-year and 90-day mortality. The results were adjusted for age, sex, year of operation, comorbidities, histology, neoadjuvant treatment, and pathologic stage. RESULTS A total of 1338 patients underwent THE (n = 323) or TTE (n = 1015). The observed 5-year survival rate was 39.3% after THE and 45.0% after TTE (p = 0.072). In adjusted model 1, THE was not associated with greater 5-year mortality (HR 0.99; 95% CI 0.82-1.20) than TTE. In adjusted model 2, including T stage instead of pathologic stage, the 5-year mortality hazard rates after THE (HR 0.87, 95% CI 0.72-1.05) and TTE were comparable. The 90-day mortality rate for THE was higher than for TTE (adjusted HR 0.72; 95% CI 0.45-1.14). In subgroup analyses, no differences between THE and TTE were observed in Siewert II gastroesophageal junction cancers, esophageal cancers, or pN0 tumors, nor in the comparison of THE and TTE with two-field lymphadenectomy. The sensitivity analysis, including patients with missing patient records, who underwent surgery during 1996-2016 mirrored the main analysis. CONCLUSIONS This Finnish population-based nationwide study suggests no difference in 5-year or 90-day mortality after THE and TTE for esophageal cancer.
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Affiliation(s)
- Anna Junttila
- Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland.
| | - Olli Helminen
- Surgery Research Unit, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Mika Helmiö
- Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland
| | - Heikki Huhta
- Surgery Research Unit, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Raija Kallio
- Department of Oncology and Radiotherapy, Oulu University Hospital, Oulu, Finland
| | - Vesa Koivukangas
- Surgery Research Unit, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Arto Kokkola
- Department of Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Simo Laine
- Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland
| | - Elina Lietzen
- Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland
| | - Sanna Meriläinen
- Surgery Research Unit, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Vesa-Matti Pohjanen
- Cancer and Translational Medicine Research Unit, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Tuomo Rantanen
- Department of Surgery, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Ari Ristimäki
- Department of Pathology, HUSLAB, HUS Diagnostic Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Applied Tumor Genomics Research Program, Research Programs Unit, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jari V Räsänen
- Department of General Thoracic and Oesophageal Surgery, Heart and Lung Centre, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Juha Saarnio
- Surgery Research Unit, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Eero Sihvo
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
| | - Vesa Toikkanen
- Department of Cardiothoracic Surgery, Heart Center, Tampere University Hospital and University of Tampere, Tampere, Finland
| | - Tuula Tyrväinen
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
| | - Antti Valtola
- Department of Surgery, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Joonas H Kauppila
- Surgery Research Unit, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Insitutet and Karolinska University Hospital, Stockholm, Sweden
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Nguyen HP, Pham DAD, Dinh Nguyen D, Nguyen PV, Bui VA, Hoang MNT, Nguyen LT. Evaluating the Safety and Quality of Life of Colorectal Cancer Patients Treated by Autologous Immune Enhancement Therapy (AIET) in Vinmec International Hospitals. Int J Mol Sci 2022; 23:ijms231911362. [PMID: 36232666 PMCID: PMC9569750 DOI: 10.3390/ijms231911362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/19/2022] [Accepted: 09/21/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Colorectal cancer (CRC) is an increasingly prevalent disease with a high mortality rate in recent years. Immune cell-based therapies have received massive attention among scientists, as they have been proven effective as low-toxicity treatments. This study evaluated the safety and effectiveness of autologous immune enhancement therapy (AIET) for CRC. (2) An open-label, single-group study, including twelve patients diagnosed with stages III and IV CRC, was conducted from January 2016 to December 2021. Twelve CRC patients received one to seven infusions of natural killer (NK)-cell and cytotoxic T-lymphocyte (CTL). Multivariate modelling was used to identify factors associated with health-related quality-of-life (HRQoL) scores. (3) After 20−21 days of culture, the NK cells increased 3535-fold, accounting for 85% of the cultured cell population. Likewise, CTLs accounted for 62.4% of the cultured cell population, which was a 1220-fold increase. Furthermore, the QoL improved with increased EORTC QLQ-C30 scores, decreased symptom severity, and reduced impairment in daily living caused by these symptoms (MDASI-GI report). Finally, a 14.3 ± 14.1-month increase in mean survival time was observed at study completion. (4) AIET demonstrated safety and improved survival time and HRQoL for CRC patients in Vietnam.
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Affiliation(s)
- Hoang-Phuong Nguyen
- Vinmec Research Institute of Stem Cell and Gene Technology, Vinmec Healthcare System, Hanoi 100000, Vietnam
| | - Duc-Anh Dao Pham
- Faculty of Biology, VNU University of Science, Vietnam National University-Hanoi, 334 Nguyen Trai, Hanoi 100000, Vietnam
| | - Duy Dinh Nguyen
- Vinmec Times City International Hospital, Vinmec Healthcare System, 458 Minh Khai Street, Hanoi 100000, Vietnam
| | - Phong Van Nguyen
- Center of Applied Science, Regenerative Medicine, and Advanced Technologies (CARA), Vinmec Healthcare System, 458 Minh Khai, Hanoi 100000, Vietnam
| | - Viet-Anh Bui
- Center of Applied Science, Regenerative Medicine, and Advanced Technologies (CARA), Vinmec Healthcare System, 458 Minh Khai, Hanoi 100000, Vietnam
| | - My-Nhung Thi Hoang
- Faculty of Biology, VNU University of Science, Vietnam National University-Hanoi, 334 Nguyen Trai, Hanoi 100000, Vietnam
| | - Liem Thanh Nguyen
- Vinmec Research Institute of Stem Cell and Gene Technology, Vinmec Healthcare System, Hanoi 100000, Vietnam
- College of Health Sciences, Vin University, Hanoi 100000, Vietnam
- Correspondence:
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Sugawara K, Yagi K, Aikou S, Yamashita H, Seto Y. Impacts of complications after esophageal cancer surgery on health-related quality of life and nutritional status. Gen Thorac Cardiovasc Surg 2022; 70:1048-1057. [PMID: 35788889 DOI: 10.1007/s11748-022-01846-y] [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: 04/25/2022] [Accepted: 06/07/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The long-term impacts of post-operative complications, especially pulmonary complications and anastomotic leakage, on health-related quality of life (HRQoL), nutritional status and body composition remain to be fully addressed in patients undergoing esophageal cancer surgery. METHODS Patients who underwent esophagectomy between 2015 and 2019 and survived without recurrence were eligible. HRQoL (European Organization for Research and Treatment of Cancer QLQ-C30 and the QLQ-OES18 questionnaires), nutritional and body composition data were prospectively evaluated before and at 3, 6, 12 and 24 months after surgery. Collected data were compared between patients with post-operative complications and those without. RESULTS In total, 88 patients were included. Overall complications, anastomotic leakage and pulmonary complications developed in 48 (54.5%), 20 (20.7%) and 18 (20.5%) patients, respectively. Patients with pulmonary complications had significantly more reflux-related symptoms (dry mouth; P = 0.03, coughing; P = 0.047), and more difficulties with eating at 24 months after surgery, as compared to those without such complications. Anastomotic leakage increased pain, speaking problems and dysphagia up to 6 months after surgery. Patients with pulmonary complications had significantly lower prealbumin levels (P = 0.01, 0.02 and 0.008 at 6, 12 and 24 months after surgery, respectively) and lower prognostic nutritional index values over time after surgery than those without these complications. In contrast, anastomotic leakage was not associated with poor nutritional status post-operatively. Body composition was not affected by the occurrence of complications. CONCLUSION Patients who developed post-operative complications, especially pulmonary complications, had long-lasting negative HRQoL outcomes and poor nutritional status after esophagectomy.
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Affiliation(s)
- Kotaro Sugawara
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Koichi Yagi
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Susumu Aikou
- Division of Frontier Surgery, Advanced Clinical Research Center, Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Hiroharu Yamashita
- Department of Digestive Surgery, Surugadai Nihon University Hospital, Tokyo, Japan
| | - Yasuyuki Seto
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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Liu Y, Pettersson E, Schandl A, Markar S, Johar A, Lagergren P. Dispositional optimism and all-cause mortality after esophageal cancer surgery: a nationwide population-based cohort study. Support Care Cancer 2022; 30:9461-9469. [PMID: 35953730 PMCID: PMC9371627 DOI: 10.1007/s00520-022-07311-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 08/03/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE To examine the association between dispositional optimism and all-cause mortality after esophageal cancer surgery and whether pathological tumor stage and the COVID-19 pandemic modified this association. METHODS This nationwide, population-based prospective cohort study included 335 patients undergoing esophageal cancer surgery in Sweden between January 1, 2013, and December 31, 2019. Dispositional optimism was measured 1 year post-surgery using Life Orientation Test-Revised (LOT-R). A higher LOT-R sum score represents higher dispositional optimism. Mortality information was obtained from the Swedish Register of the Total Population. All patients were followed up until death or until December 31, 2020, whichever occurred first. Cox regression with adjustments for confounders was used. RESULTS The median follow-up was 20.8 months, during which 125 (37.3%) patients died. Among the included 335 patients, 219 (65.4%) patients had tumor pathologically staged Tis-II, and 300 (89.6%) patients entered the cohort before the COVID-19 pandemic. Both tumor stage and the COVID-19 pandemic were effect modifiers. For each unit increase in LOT-R sum score, the risk of all-cause mortality decreased by 11% (HR 0.89, 95% CI 0.81 to 0.98) among patients with tumor staged Tis-II before the COVID-19 pandemic. This association was non-significant in patients with tumor staged III-IV (HR 0.99, 95% CI 0.92 to 1.07) and during the COVID-19 pandemic (HR 1.08, 95% CI 0.94 to 1.25). CONCLUSION Assessing dispositional optimism may help predict postoperative survival, especially for patients with early and intermediate esophageal cancer. Increasing dispositional optimism might be a potential intervention target to improve survival after esophageal cancer surgery.
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Affiliation(s)
- Yangjun Liu
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Retzius väg 13a, Level 4, 171 77, Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Erik Pettersson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Anna Schandl
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Retzius väg 13a, Level 4, 171 77, Stockholm, Sweden
- Department of Anaesthesiology and Intensive Care, Södersjukhuset, Stockholm, Sweden
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Sheraz Markar
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Retzius väg 13a, Level 4, 171 77, Stockholm, Sweden
- Nuffield Department of Surgery, University of Oxford, Oxford, UK
| | - Asif Johar
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Retzius väg 13a, Level 4, 171 77, Stockholm, Sweden
| | - Pernilla Lagergren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Retzius väg 13a, Level 4, 171 77, Stockholm, Sweden.
- Department of Surgery and Cancer, Imperial College London, 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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Stevens JP, Dechen T, Schwartzstein RM, O'Donnell CR, Baker K, Banzett RB. Association of dyspnoea, mortality and resource use in hospitalised patients. Eur Respir J 2021; 58:1902107. [PMID: 33653806 DOI: 10.1183/13993003.02107-2019] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 01/17/2021] [Indexed: 12/30/2022]
Abstract
As many as one in 10 patients experience dyspnoea at hospital admission but the relationship between dyspnoea and patient outcomes is unknown. We sought to determine whether dyspnoea on admission predicts outcomes.We conducted a retrospective cohort study in a single, academic medical centre. We analysed 67 362 consecutive hospital admissions with available data on dyspnoea, pain and outcomes. As part of the Initial Patient Assessment by nurses, patients rated "breathing discomfort" using a 0 to 10 scale (10="unbearable"). Patients reported dyspnoea at the time of admission and recalled dyspnoea experienced in the 24 h prior to admission. Outcomes included in-hospital mortality, 2-year mortality, length of stay, need for rapid response system activation, transfer to the intensive care unit, discharge to extended care, and 7- and 30-day all-cause readmission to the same institution.Patients who reported any dyspnoea were at an increased risk of death during that hospital stay; the greater the dyspnoea, the greater the risk of death (dyspnoea 0: 0.8% in-hospital mortality; dyspnoea 1-3: 2.5% in-hospital mortality; dyspnoea ≥4: 3.7% in-hospital mortality; p<0.001). After adjustment for patient comorbidities, demographics and severity of illness, increasing dyspnoea remained associated with inpatient mortality (dyspnoea 1-3: adjusted OR 2.1, 95% CI 1.7-2.6; dyspnoea ≥4: adjusted OR 3.1, 95% CI 2.4-3.9). Pain did not predict increased mortality. Patients reporting dyspnoea also used more hospital resources, were more likely to be readmitted and were at increased risk of death within 2 years (dyspnoea 1-3: adjusted hazard ratio 1.5, 95% CI 1.3-1.6; dyspnoea ≥4: adjusted hazard ratio 1.7, 95% CI 1.5-1.8).We found that dyspnoea of any rating was associated with an increased risk of death. Dyspnoea ratings can be rapidly collected by nursing staff, which may allow for better monitoring or interventions that could reduce mortality and morbidity.
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Affiliation(s)
- Jennifer P Stevens
- Center for Healthcare Delivery Science, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Division for Pulmonary, Critical Care, and Sleep Medicine, Dept of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Tenzin Dechen
- Center for Healthcare Delivery Science, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Richard M Schwartzstein
- Division for Pulmonary, Critical Care, and Sleep Medicine, Dept of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Carl R O'Donnell
- Division for Pulmonary, Critical Care, and Sleep Medicine, Dept of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Kathy Baker
- Lois E. Silverman Dept of Nursing, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Robert B Banzett
- Division for Pulmonary, Critical Care, and Sleep Medicine, Dept of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Abstract
OBJECTIVE We aimed to develop prediction models for estimating the long-term survival in patients who have undergone surgery for esophageal cancer. BACKGROUND Few prediction models have been developed for the long-term survival in esophageal cancer patients. METHODS This nationwide Swedish population-based cohort study included 1542 patients who survived for ≥90 days after esophageal cancer surgery between 1987 and 2010, with follow-up until 2016. Risk prediction models for 1-, 3-, and 5-year all-cause mortality and 3- and 5-year disease-specific mortality were developed using logistic regression. Candidate predictors were established and readily identifiable prognostic factors. The performance of the models was assessed by the area under receiver-operating characteristic curve (AUC) with interquartile range (IQR) using bootstrap cross-validation and risk calibration. RESULTS Predictors included in all models were age, sex, pathological tumor stage, tumor histology, and resection margin status. The models also included various additional predictors depending on the outcome, that is, education level, neoadjuvant therapy, reoperation (within 30 d of primary surgery) and comorbidity (Charlson comorbidity index). The AUC statistics after cross-validation were 0.71 (IQR 0.69-0.74) for 1-year, 0.77 (IQR 0.75-0.80) for 3-year, and 0.78 (IQR 0.76-0.81) for 5-year all-cause mortality. The corresponding values were 0.76 (IQR 0.74-0.79) for 3-year and 0.77 (IQR 0.71-0.83) for 5-year disease-specific mortality. All models showed good agreement between the observed and predicted risks. CONCLUSIONS These models showed good performance for predicting long-term survival after esophageal cancer surgery and may thus be useful for patients in planning their lives and to guide the postoperative treatment and follow-up.
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10
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Liu Y, Pettersson E, Schandl A, Markar S, Johar A, Lagergren P. Higher Dispositional Optimism Predicts Better Health-Related Quality of Life After Esophageal Cancer Surgery: A Nationwide Population-Based Longitudinal Study. Ann Surg Oncol 2021; 28:7196-7205. [PMID: 33876352 PMCID: PMC8521517 DOI: 10.1245/s10434-021-10026-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/26/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE To assess whether higher dispositional optimism could predict better health-related quality of life (HRQL) after esophageal cancer surgery. METHODS This Swedish nationwide longitudinal study included 192 patients who underwent esophagectomy for cancer. The exposure was dispositional optimism measured by the Life Orientation Test-Revised (LOT-R) at 1 year post-surgery. Patients were categorized into four subgroups (very low, moderately low, moderately high, and very high dispositional optimism) based on the quartile of the LOT-R sum score. The outcome was HRQL assessed by the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Core 30 (QLQ-C30) and Quality of Life Questionnaire-Esophago-Gastric module 25 (QLQ-OG25) at 1, 1.5, and 2 years post-surgery. Linear mixed-effects models, adjusted for potential confounders, were used to examine the mean score difference (MSD) with 95% confidence interval of HRQL among the four patient subgroups. RESULTS Patients with very high dispositional optimism reported clinically relevantly better global quality of life, emotional function, and social function (MSD range 10-16) and less severe symptoms in pain, dyspnea, diarrhea, eating difficulty, anxiety, dry mouth, trouble with taste, worry about weight loss, and self-doubt about body image (MSD range - 9 to - 22) than patients with lower dispositional optimism. Patients with moderately high dispositional optimism reported clinically and statistically significantly better global quality of life (MSD 10) and less severe diarrhea (MSD - 9) than patients with lower dispositional optimism. Adjusted MSDs were constant over the three time points in all aspects except for eating difficulty. CONCLUSIONS Measuring dispositional optimism could help identify patients at higher risk of poor HRQL recovery after esophageal cancer surgery.
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Affiliation(s)
- Yangjun Liu
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Erik Pettersson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Anna Schandl
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.,Department of Anesthesiology and Intensive Care, Södersjukhuset, Stockholm, Sweden
| | - Sheraz Markar
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - Asif Johar
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Pernilla Lagergren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden. .,Department of Surgery and Cancer, Imperial College London, London, UK.
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11
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Moss MCL, Aggarwal A, Qureshi A, Taylor B, Guerrero-Urbano T, Van Hemelrijck M. An assessment of the use of patient reported outcome measurements (PROMs) in cancers of the pelvic abdominal cavity: identifying oncologic benefit and an evidence-practice gap in routine clinical practice. Health Qual Life Outcomes 2021; 19:20. [PMID: 33451330 PMCID: PMC7810193 DOI: 10.1186/s12955-020-01648-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 12/09/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patient reported outcome measurements (PROMs) are emerging as an important component of patient management in the cancer setting, providing broad perspectives on patients' quality of life and experience. The use of PROMs is, however, generally limited to the context of randomised control trials, as healthcare services are challenged to sustain high quality of care whilst facing increasing demand and financial shortfalls. We performed a systematic review of the literature to identify any oncological benefit of using PROMs and investigate the wider impact on patient experience, in cancers of the pelvic abdominal cavity specifically. METHODS A systematic review of the literature was conducted using MEDLINE (Pubmed) and Ovid Gateway (Embase and Ovid) until April 2020. Studies investigating the oncological outcomes of PROMs were deemed suitable for inclusion. RESULTS A total of 21 studies were included from 2167 screened articles. Various domains of quality of life (QoL) were identified as potential prognosticators for oncologic outcomes in cancers of the pelvic abdominal cavity, independent of other clinicopathological features of disease: 3 studies identified global QoL as a prognostic factor, 6 studies identified physical and role functioning, and 2 studies highlighted fatigue. In addition to improved outcomes, a number of included studies also reported that the use of PROMs enhanced both patient-clinician communication and patient satisfaction with care in the clinical setting. CONCLUSIONS This review highlights the necessity of routine collection of PROMs within the pelvic abdominal cancer setting to improve patient quality of life and outcomes.
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Affiliation(s)
- Miss Charlotte L Moss
- King's College London, School of Cancer and Pharmaceutical Sciences, Translational Oncology and Urology Research (TOUR), Guy's Hospital, 3rd Floor Bermondsey Wing, Great Maze Pond, London, SE1 9RT, UK.
| | - Ajay Aggarwal
- Comprehensive Cancer Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Asad Qureshi
- Comprehensive Cancer Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Benjamin Taylor
- Comprehensive Cancer Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Mieke Van Hemelrijck
- King's College London, School of Cancer and Pharmaceutical Sciences, Translational Oncology and Urology Research (TOUR), Guy's Hospital, 3rd Floor Bermondsey Wing, Great Maze Pond, London, SE1 9RT, UK
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12
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Liu YJ, Schandl A, Markar S, Johar A, Lagergren P. Psychological distress and health-related quality of life up to 2 years after oesophageal cancer surgery: nationwide population-based study. BJS Open 2021; 5:6073387. [PMID: 33609371 PMCID: PMC7893460 DOI: 10.1093/bjsopen/zraa038] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 10/12/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Patients are at higher risk of suffering from psychological distress and reduced health-related quality of life (HRQoL) after oesophageal cancer surgery. This Swedish nationwide population-based longitudinal study aimed to evaluate the association between psychological distress and HRQoL up to 2 years after oesophageal cancer surgery. METHODS The study included patients with oesophageal cancer who had survived for 1 year after oesophageal cancer surgery. The exposure was psychological distress measured using the Hospital Anxiety and Depression Scale. Patients scoring at least 8 on either the anxiety or the depression subscale were classified as having psychological distress. The outcome was HRQoL assessed by the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire generic and disease-specific questionnaires (EORTC QLQ-C30 and QLQ-OG25). Exposure and outcome were measured at 1, 1.5, and 2 years after operation. Fixed-effects models with adjustment for all time-invariant confounding and potential time-varying confounders were used to examine the mean score difference in HRQoL between patients with and without psychological distress. RESULTS In total, 180 patients were analysed. Clinically relevant, statistically significant and time-constant mean score differences were found in emotional function, social function, dyspnoea, anxiety, eating difficulty, eating in front of others, and weight loss (mean score difference range 10-29). Mean score differences for global quality of life, cognitive function, appetite loss, EORTC QLQ-C30 summary score, and trouble with taste increased over time, and reached clinical and statistical significance at 1.5 and/or 2 years after surgery. For body image, there was a clinically relevant decrease in mean score difference over time. CONCLUSION Psychological distress was associated with several aspects of poor HRQoL up to 2 years after surgery for oesophageal cancer.
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Affiliation(s)
- Y J Liu
- Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - A 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
| | - S Markar
- 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
| | - A Johar
- Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - P Lagergren
- Correspondence to: Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Retzius väg 13 a, Level 4, 171 77 Stockholm, Sweden (e-mail: )
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13
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Moss JL, Pinto CN, Mama SK, Rincon M, Kent EE, Yu M, Cronin KA. Rural-urban differences in health-related quality of life: patterns for cancer survivors compared to other older adults. Qual Life Res 2020; 30:1131-1143. [PMID: 33136241 DOI: 10.1007/s11136-020-02683-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE Health-related quality of life (HRQOL) among older cancer survivors can be impaired by factors such as treatment, comorbidities, and social challenges. These HRQOL impairments may be especially pronounced in rural areas, where older adults have higher cancer burden and more comorbidities and risk factors for poor health. This study aimed to assess rural-urban differences in HRQOL for older cancer survivors and controls. METHODS Data came from Surveillance, Epidemiology, and End Results-Medicare Health Outcomes Survey (SEER-MHOS), which links cancer incidence from 18 U.S. population-based cancer registries to survey data for Medicare Advantage Organization enrollees (1998-2014). HRQOL measures were 8 standardized subscales and 2 global summary measures. We matched (2:1) controls to breast, colorectal, lung, and prostate cancer survivors, creating an analytic dataset of 271,640 participants (ages 65+). HRQOL measures were analyzed with linear regression models including multiplicative interaction terms (rurality by cancer status), controlling for sociodemographics, cohort, and multimorbidities. RESULTS HRQOL scores were higher in urban than rural areas (e.g., global physical component summary score for breast cancer survivors: urban mean = 38.7, standard error [SE] = 0.08; rural mean = 37.9, SE = 0.32; p < 0.05), and were generally lower among cancer survivors compared to controls. Rural cancer survivors had particularly poor vitality (colorectal: p = 0.05), social functioning (lung: p = 0.05), role limitation-physical (prostate: p < 0.01), role limitation-emotional (prostate: p < 0.01), and global mental component summary (prostate: p = 0.02). CONCLUSION Supportive interventions are needed to increase physical, social, and emotional HRQOL among older cancer survivors in rural areas. These interventions could target cancer-related stigma (particularly for lung and prostate cancers) and/or access to screening, treatment, and ancillary healthcare resources.
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Affiliation(s)
- Jennifer L Moss
- National Cancer Institute, Bethesda, MD, USA. .,Penn State College of Medicine, 500 University Drive, Hershey, PA, 17033, USA.
| | - Casey N Pinto
- Penn State College of Medicine, 500 University Drive, Hershey, PA, 17033, USA
| | | | | | - Erin E Kent
- University of North Carolina, Chapel Hill, NC, USA
| | - Mandi Yu
- National Cancer Institute, Bethesda, MD, USA
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14
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van den Boorn HG, Stroes CI, Zwinderman AH, Eshuis WJ, Hulshof MCCM, van Etten-Jamaludin FS, Sprangers MAG, van Laarhoven HWM. Health-related quality of life in curatively-treated patients with esophageal or gastric cancer: A systematic review and meta-analysis. Crit Rev Oncol Hematol 2020; 154:103069. [PMID: 32818901 DOI: 10.1016/j.critrevonc.2020.103069] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 07/13/2020] [Accepted: 07/23/2020] [Indexed: 12/24/2022] Open
Abstract
Surgery and chemoradiotherapy can potentially cure esophageal and gastric cancer patients, although they may impact health-related quality of life (HRQoL). We aim to systemically review and meta-analyze literature to determine the effect of curative treatments on HRQoL in esophageal and gastric cancer.- A systematic search was performed identifying studies assessing HRQoL. Meta-analyses were performed on baseline and subsequent time-points.- From the 6067 articles retrieved, 49 studies were included (61 % low quality). Meta-analyses showed short-term HRQoL differences between esophageal cancer patients receiving definitive chemoradiotherapy (dCRT), neoadjuvant chemo(radio)therapy (nC(R)T), or surgery alone (p < 0.001), with better HRQoL with nC(R)T and surgery compared to dCRT. Over the course of 12 months, no HRQoL difference was identified between treatments in esophageal cancer (p = 0.633). Esophagectomy, but not gastrectomy, resulted in a clinically relevant decline in HRQoL. No long-term HRQoL differences were identified between curative treatments in esophageal and gastric cancer. More high-quality HRQoL studies are warranted.
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Affiliation(s)
- Héctor G van den Boorn
- Amsterdam UMC, University of Amsterdam, Department of Medical Oncology, Cancer Center Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Charlotte I Stroes
- Amsterdam UMC, University of Amsterdam, Department of Medical Oncology, Cancer Center Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Laboratory for Experimental Oncology and Radiobiology (LEXOR), Center for Experimental and Molecular Medicine (CEMM), Meibergdreef 9, Amsterdam, the Netherlands.
| | - Aeilko H Zwinderman
- Amsterdam UMC, University of Amsterdam, Department of Clinical Epidemiology and Biostatistics, Meibergdreef 9, Amsterdam, the Netherlands
| | - Wietse J Eshuis
- Amsterdam UMC, University of Amsterdam, Department of Surgery, Meibergdreef 9, Amsterdam, the Netherlands
| | - Maarten C C M Hulshof
- Amsterdam UMC, University of Amsterdam, Department of Radiotherapy, Meibergdreef 9, Amsterdam, the Netherlands
| | | | - Mirjam A G Sprangers
- Amsterdam UMC, University of Amsterdam, Department of Medical Psychology, Meibergdreef 9, Amsterdam, the Netherlands
| | - Hanneke W M van Laarhoven
- Amsterdam UMC, University of Amsterdam, Department of Medical Oncology, Cancer Center Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.
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15
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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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16
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Baker KM, Vragovic NS, Banzett RB. Intensive Care Nurses' Perceptions of Routine Dyspnea Assessment. Am J Crit Care 2020; 29:132-139. [PMID: 32114611 DOI: 10.4037/ajcc2020711] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Dyspnea (breathing discomfort) is commonly experienced by critically ill patients and at this time is not routinely assessed and documented. Intensive care unit nurses at the study institution recently instituted routine assessment and documentation of dyspnea in all patients able to report using a numeric scale ranging from 0 to 10. OBJECTIVE To assess nurses' perceptions of the utility of routine dyspnea measurement, patients' comprehension of assessment questions, and the impact on nursing practice and to gather nurses' suggestions for improvement. METHODS Data were obtained from interviews with intensive care unit nurses in small focus groups and an anonymous online survey randomly distributed to nurses representing all intensive care units. RESULTS Intensive care unit nurses affirmed the importance of routine dyspnea assessment and documentation. Before implementing the measurement tool, nurses often assessed for breathing discomfort in patients by using observed signs. Most nurses agreed that routine assessment can be used to predict patients' outcomes and improve patient-centered care. Nurses found the assessment tool easy to use and reported that it did not interfere with workflow. Nurses felt that patients were able to provide meaningful ratings of dyspnea, similar to ratings of pain, and often used patients' ratings in conjunction with observed physical signs to optimize patient care. CONCLUSION Our study shows that nurses understand the importance of routine dyspnea assessment and that the addition of a simple patient report scale can improve care delivery and does not add to the burden of work-flow.
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Affiliation(s)
| | - Natalia Sullivan Vragovic
- Natalia Sullivan Vragovic is a nurse practitioner in the bone marrow transplant unit, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Robert B. Banzett
- Robert B. Banzett is an associate professor, Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
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17
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Patient-Reported Symptoms for Esophageal Cancer Patients Undergoing Curative Intent Treatment. Ann Thorac Surg 2020; 109:367-374. [DOI: 10.1016/j.athoracsur.2019.08.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 07/08/2019] [Accepted: 08/08/2019] [Indexed: 02/03/2023]
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18
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Garant A, Whitaker TJ, Spears GM, Routman DM, Harmsen WS, Wilhite TJ, Ashman JB, Sio TT, Rule WG, Neben Wittich MA, Martenson JA, Tryggestad EJ, Yoon HH, Blackmon S, Merrell KW, Haddock MG, Hallemeier CL. A Comparison of Patient-Reported Health-Related Quality of Life During Proton Versus Photon Chemoradiation Therapy for Esophageal Cancer. Pract Radiat Oncol 2019; 9:410-417. [DOI: 10.1016/j.prro.2019.07.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 07/01/2019] [Accepted: 07/02/2019] [Indexed: 12/17/2022]
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19
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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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20
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Predictive Impact of Clinical Benefit in Chemotherapy-treated Advanced Pancreatic Cancer Patients in Northern Alberta. Am J Clin Oncol 2019; 41:867-873. [PMID: 28368922 DOI: 10.1097/coc.0000000000000385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Patients with advanced pancreatic cancer (APC) have a poor prognosis and experience a large burden of disease-related symptoms. Despite advancements in the treatment of APC, survival is dismal and controlling disease-related symptoms and maintaining quality of life is paramount. We hypothesize that an improvement in disease-related symptoms, and therefore, a clinical benefit, while on chemotherapy is a predictive marker in APC. MATERIALS AND METHODS Patients 18 and older with APC diagnosed between January 1, 2005 and December 31, 2010 and treated at the Cross Cancer Institute were identified using the provincial cancer registry. Disease symptoms were assessed at baseline and clinical benefit while on chemotherapy was defined using a composite endpoint of improvement in patient-reported pain, opioid consumption, Eastern Cooperative Oncology Group performance status, and/or weight. Best radiologic response, progression-free survival (PFS), and overall survival (OS) were recorded. RESULTS Of 103 patients, the median age was 64, 58% were male and 66% had metastatic disease. At baseline, the majority of patients reported pain (80%), opioid use (61%), or weight loss (71%). In total, 35 (34%) patients received a clinical benefit with treatment but only 6 (17%) of these patients experienced a radiologic response. The median PFS and OS were improved in patients who experienced a clinical benefit (6.6 vs. 4.6 mo; P=0.03 and 11.7 vs. 6.1 mo; P<0.0001, respectively). CONCLUSIONS In patients with APC treated with chemotherapy, experiencing a clinical benefit was associated with improved PFS and OS. However, it did not appear to correlate with radiologic response to chemotherapy. Prospective studies are warranted to further investigate the prognostic and predictive value of clinical benefit and improvement in quality of life as measured by standardized tools, in APC.
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21
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Hirpara DH, Gupta V, Brown L, Kidane B. Patient-reported outcomes in lung and esophageal cancer. J Thorac Dis 2019; 11:S509-S514. [PMID: 31032069 DOI: 10.21037/jtd.2019.01.02] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Carcinomas of the lung and esophagus are associated with significant disease and treatment related morbidity. Measuring patients' self-perceived notion of their health-related quality of life (HRQOL), throughout the course of illness, is central to the delivery of comprehensive, patient-centered care. This article reviews commonly used HRQOL instruments in thoracic surgery and discusses the integral role of patient-reported outcomes (PROs) in comparative effectiveness research and prognostication in the realm of lung and esophageal cancer. We also highlight challenges and future directions for widespread implementation of PROs into clinical and research practice.
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Affiliation(s)
- Dhruvin H Hirpara
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Vaibhav Gupta
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Lisa Brown
- Department of Surgery, University of California, Davis, Sacramento, California, USA.,Thoracic Surgery Outcomes Research Network (ThORN)
| | - Biniam Kidane
- Thoracic Surgery Outcomes Research Network (ThORN).,Section of Thoracic Surgery, Health Sciences Center, Winnipeg, Manitoba, Canada
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22
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Minnella EM, Awasthi R, Loiselle SE, Agnihotram RV, Ferri LE, Carli F. Effect of Exercise and Nutrition Prehabilitation on Functional Capacity in Esophagogastric Cancer Surgery: A Randomized Clinical Trial. JAMA Surg 2018; 153:1081-1089. [PMID: 30193337 PMCID: PMC6583009 DOI: 10.1001/jamasurg.2018.1645] [Citation(s) in RCA: 261] [Impact Index Per Article: 43.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 03/18/2018] [Indexed: 12/17/2022]
Abstract
Importance Preserving functional capacity is a key element in the care continuum for patients with esophagogastric cancer. Prehabilitation, a preoperative conditioning intervention aiming to optimize physical status, has not been tested in upper gastrointestinal surgery to date. Objective To investigate whether prehabilitation is effective in improving functional status in patients undergoing esophagogastric cancer resection. Design, Setting, and Participants A randomized clinical trial (available-case analysis based on completed assessments) was conducted at McGill University Health Centre (Montreal, Quebec, Canada) comparing prehabilitation with a control group. Intervention consisted of preoperative exercise and nutrition optimization. Participants were adults awaiting elective esophagogastric resection for cancer. The study dates were February 13, 2013, to February 10, 2017. Main Outcomes and Measures The primary outcome was change in functional capacity, measured with absolute change in 6-minute walk distance (6MWD). Preoperative (end of the prehabilitation period) and postoperative (from 4 to 8 weeks after surgery) data were compared between groups. Results Sixty-eight patients were randomized, and 51 were included in the primary analysis. The control group were a mean (SD) age, 68.0 (11.6) years and 20 (80%) men. Patients in the prehabilitation group were a mean (SD) age, 67.3 (7.4) years and 18 (69%) men. Compared with the control group, the prehabilitation group had improved functional capacity both before surgery (mean [SD] 6MWD change, 36.9 [51.4] vs -22.8 [52.5] m; P < .001) and after surgery (mean [SD] 6MWD change, 15.4 [65.6] vs -81.8 [87.0] m; P < .001). Conclusions and Relevance Prehabilitation improves perioperative functional capacity in esophagogastric surgery. Keeping patients from physical and nutritional status decline could have a significant effect on the cancer care continuum. Trial Registration ClinicalTrials.gov Identifier: NCT01666158.
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Affiliation(s)
- Enrico M. Minnella
- Department of Anesthesia, McGill University Health Centre, Montreal General Hospital, Montreal, Quebec, Canada
| | - Rashami Awasthi
- Department of Anesthesia, McGill University Health Centre, Montreal General Hospital, Montreal, Quebec, Canada
| | - Sarah-Eve Loiselle
- Department of Anesthesia, McGill University Health Centre, Montreal General Hospital, Montreal, Quebec, Canada
| | | | - Lorenzo E. Ferri
- Division of Thoracic Surgery, McGill University Health Centre, Montreal General Hospital, Montreal, Quebec, Canada
| | - Francesco Carli
- Department of Anesthesia, McGill University Health Centre, Montreal General Hospital, Montreal, Quebec, Canada
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Anandavadivelan P, Wikman A, Johar A, Lagergren P. Profiles of patient and tumour characteristics in relation to health-related quality of life after oesophageal cancer surgery. PLoS One 2018; 13:e0196187. [PMID: 29708994 PMCID: PMC5927451 DOI: 10.1371/journal.pone.0196187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 03/18/2018] [Indexed: 12/17/2022] Open
Abstract
Strong deterioration in health-related quality of life (HRQOL) is a major concern in a sub-group of long-term oesophageal cancer survivors. This study aimed to identify potential clustering of patients and tumour variables that predicts such deterioration. Patient and tumour variables were collected in a prospective cohort of patients who underwent surgery for oesophageal cancer in Sweden 2001-2005. Latent cluster analysis identified statistically significant clustering of these variables. Multivariable logistic regression adjusted for age, BMI, tumour stage and marital status was used to determine odds ratios (ORs) with 95% confidence intervals (CIs) between patient profiles and HRQOL at 3 and 5 years from surgery. Among 155 included patients at 3 years, three patient profiles were identified: 1) 'reference profile' (males, younger age, employed, upper secondary education, co-habitating, urban dwellers, adenocarcinoma and advanced tumour stage) (n = 47;30%), 2) 'adenocarcinoma profile' (middle age, unemployed/retired, males, low education, co-habitating, adenocarcinoma, advanced tumour stage, tumour in lower oesophagus/cardia, and co-morbidities (n = 79;51%), and 3) 'squamous-cell carcinoma profile' (unemployed/retired, middle-age, males, low BMI, urban dwellers, squamous-cell carcinoma, tumour in upper/middle oesophagus (n = 29;19%). These profiles did not differ regarding most HRQOL measures. Exceptions were the squamous-cell carcinoma profile, reporting more constipation (OR = 5.69; 95%CI: 1.34-24.28) and trouble swallowing saliva (OR = 4.87; 95%CI: 1.04-22.78) and the adenocarcinoma profile reporting more dyspnoea (OR = 2.60; 95%CI: 1.00-6.77) and constipation (OR = 3.31; 95%CI: 1.00-10.97) compared to the reference profile. Three distinct patient profiles were identified but these could not explain the substantial deterioration in HRQOL observed in the sub-sample of survivors.
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Affiliation(s)
- Poorna Anandavadivelan
- Surgical Care Science, Department of Molecular medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Wikman
- Reproductive Health, Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Asif Johar
- Surgical Care Science, Department of Molecular medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Pernilla Lagergren
- Surgical Care Science, Department of Molecular medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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Kauppila JH, Johar A, Gossage JA, Davies AR, Zylstra J, Lagergren J, Lagergren P. Health-related quality of life after open transhiatal and transthoracic oesophagectomy for cancer. Br J Surg 2018; 105:230-236. [DOI: 10.1002/bjs.10745] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 09/11/2017] [Accepted: 10/02/2017] [Indexed: 01/07/2023]
Abstract
Abstract
Background
Transhiatal and transthoracic oesophagectomy in patients with oesophageal cancer have similar survival rates. Whether these approaches differ in health-related quality of life (HRQoL) is uncertain and was examined in this study.
Methods
Patients undergoing transhiatal or transthoracic surgery for lower-third oesophageal or gastro-oesophageal junctional cancer between 2011 and 2015 were selected from an institutional database. HRQoL outcomes were measured at 6 and 12 months after surgery using validated written questionnaires (European Organisation for Research and Treatment of Cancer QLQ-C30 and QLQ-OG25). Linear mixed models provided mean score differences (MSDs) with 95 per cent confidence intervals, adjusted for preoperative HRQoL, age, physical status (ASA fitness grade), tumour location, tumour stage, neoadjuvant therapy, adjuvant therapy and postoperative complications. MSD values of 10 or more were regarded as clinically relevant.
Results
Some 146 patients underwent transhiatal (86, 58·9 per cent) or transthoracic (60, 41·1 per cent) oesophagectomy. The HRQoL questionnaires were returned by 111 patients at 6 months and 74 at 12 months. At 6 months, transthoracic oesophagectomy was associated with worse role function (MSD –12, 95 per cent c.i. –23 to 0; P = 0·046). At 12 months, patients in the transthoracic group had more nausea and vomiting (MSD 11, 0 to 22; P = 0·045), dyspnoea (MSD 13, 1 to 25; P = 0·029) and constipation (MSD 20, 7 to 33; P = 0·003) than those in the transhiatal group.
Conclusion
Transhiatal oesophagectomy seems to offer better HRQoL than transthoracic oesophagectomy 6 and 12 months after surgery.
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Affiliation(s)
- J H Kauppila
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
- Cancer and Translational Medicine Research Unit, Medical Research Centre, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - A Johar
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - J A Gossage
- Division of Cancer Studies, King's College London, London, UK
- Department of Surgery, Guy's and St Thomas' Oesophago-Gastric Centre, London, UK
| | - A R Davies
- Division of Cancer Studies, King's College London, London, UK
- Department of Surgery, Guy's and St Thomas' Oesophago-Gastric Centre, London, UK
| | - J Zylstra
- Division of Cancer Studies, King's College London, London, UK
- Department of Surgery, Guy's and St Thomas' Oesophago-Gastric Centre, London, UK
| | - J Lagergren
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
- Division of Cancer Studies, King's College London, London, UK
- Department of Surgery, Guy's and St Thomas' Oesophago-Gastric Centre, London, UK
| | - P Lagergren
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
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Kauppila JH, Ringborg C, Johar A, Lagergren J, Lagergren P. Health-related quality of life after gastrectomy, esophagectomy, and combined esophagogastrectomy for gastroesophageal junction adenocarcinoma. Gastric Cancer 2018; 21:533-541. [PMID: 28852939 PMCID: PMC5906505 DOI: 10.1007/s10120-017-0761-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 08/16/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND The postoperative health-related quality of life (HRQOL) outcomes in patients with gastroesophageal junction (GEJ) adenocarcinoma after gastrectomy and esophagectomy are unclear. The aim was to evaluate HRQOL outcomes 6 months after extended total gastrectomy, subtotal esophagectomy, and combined esophagogastrectomy. METHODS Patients who underwent surgery for GEJ adenocarcinoma of Siewert type 2 or 3 in 2001-2005 were identified from a nationwide Swedish prospective and population-based cohort. Three surgical strategies, i.e., gastrectomy, esophagectomy, or esophagogastrectomy, were analyzed in relationship to HRQOL measured at 6 months after surgery (main outcome). HRQOL was assessed using well-validated questionnaires for general (EORTC QLQ-C30) and esophageal cancer-specific (EORTC QLQ-OES18) symptoms. Mean score differences (MSD) and 95% confidence intervals (CI) were analyzed using ANCOVA and adjusted for age, sex, tumor stage, comorbidity, education level, hospital volume, and postoperative complications. MSDs > 10 were regarded as clinically relevant. RESULTS Among 176 patients with complete information on HRQOL and covariates, none of the MSDs for HRQOL among the three surgery groups were clinically and statistically significant. MSDs comparing esophagectomy and gastrectomy showed no major differences in global quality of life (MSD, +8, 95% CI, 0 to +16), physical function (MSD, +2, 95% CI, -5 to +9), pain (MSD, -3, 95% CI, -12 to +7), or reflux (MSD, +5, 95% CI, -4 to +14). Also, complication rates and 5-year survival rates were similar comparing esophagectomy and gastrectomy. CONCLUSIONS Extended total gastrectomy, subtotal esophagectomy, and combined esophagogastrectomy seemed to yield similar 6-month postoperative HRQOL outcomes for patients with GEJ adenocarcinoma.
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Affiliation(s)
- Joonas H. Kauppila
- 0000 0000 9241 5705grid.24381.3cUpper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, 17176 Stockholm, Sweden ,Cancer and Translational Medicine Research Unit, Medical Research Center Oulu, University of Oulu, Oulu University Hospital, Oulu, Finland
| | - Cecilia Ringborg
- 0000 0000 9241 5705grid.24381.3cSurgical Care Sciences, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, 17176 Stockholm, Sweden
| | - Asif Johar
- 0000 0000 9241 5705grid.24381.3cSurgical Care Sciences, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, 17176 Stockholm, Sweden
| | - Jesper Lagergren
- 0000 0000 9241 5705grid.24381.3cUpper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, 17176 Stockholm, Sweden ,grid.420545.2Division of Cancer Studies, King’s College London and Guy’s and St. Thomas’ NHS Foundation Trust, London, England, UK
| | - Pernilla Lagergren
- 0000 0000 9241 5705grid.24381.3cSurgical Care Sciences, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, 17176 Stockholm, Sweden
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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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Donohoe CL, Healy LA, Fanning M, Doyle SL, Hugh AM, Moore J, Ravi N, Reynolds JV. Impact of supplemental home enteral feeding postesophagectomy on nutrition, body composition, quality of life, and patient satisfaction. Dis Esophagus 2017; 30:1-9. [PMID: 28859364 DOI: 10.1093/dote/dox063] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Indexed: 12/11/2022]
Abstract
The aim of this prospective cohort study is to analyze the impact of supplemental home enteral nutrition (HEN) post-esophageal cancer surgery on nutritional parameters, quality of life (QL), and patient satisfaction. A systematic review reported that over 60% of patients lose >10% of both body weight and BMI by 6 months after esophagectomy. Enteral feeding (EF) is increasingly a modern standard postoperatively; however, the impact of extended HEN postdischarge has not been systematically studied. One hundred forty-nine consecutive patients [mean age 62 ± 9, 80% male,76% adenocarcinoma, 66% on multimodal protocols, and 69% with BMI ≥ 25 kg/m2] were studied. Jejunal EF commenced day 1 postoperatively, and supplemental overnight HEN (764 kcal; 32g protein) continued on discharge for a planned further 4 weeks. Weight, BMI, and body composition analysis (bioimpedance analysis) were measured at baseline, preoperatively and at 1, 3, and 6 months, along with the EORTC QLQ-C30/OES18 QL measures. A patient satisfaction questionnaire addressed eight key items in relation to HEN (max score 100/item). Median (range) total duration of EF was 49 days (28-96). Overall compliance was 96%. At 6 months, compared with preoperatively, 58 (39%) patients lost >10% weight, with median (IQR) loss of 6.8 (4-9) kg, and 62 (41%) patients lost >10% BMI. Lean body mass and body fat were significantly (p < 0.001) decreased. Mean global QL decreased (p < 0.01) from 82 to 72. A high mean satisfaction score (>70 ± 11/100) was reported, >80 for practical training, activities of daily living, pain, anxiety, recovery and impact on caregivers, with lower scores for appetite (33 ± 24) and sleep (63 ± 30). Supplemental HEN for a minimum of one month postdischarge is associated with high compliance and patient satisfaction. Weight and BMI loss may still be substantial, however this may be less than published literature, in addition the impact on HR-QL may be attenuated. HEN has both subjective and objective rationale and merits further validation toward optimizing nutritional recovery and overall wellbeing.
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Affiliation(s)
| | - L A Healy
- Clinical Nutrition, St. James's Hospital and Trinity College Dublin
| | - M Fanning
- Clinical Nutrition, St. James's Hospital and Trinity College Dublin
| | - S L Doyle
- Department of Surgery.,School of Biological Sciences, Dublin Institute of Technology, Dublin, Ireland
| | - A Mc Hugh
- Clinical Nutrition, St. James's Hospital and Trinity College Dublin
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Phippen NT, Secord AA, Wolf S, Samsa G, Davidson B, Abernethy AP, Cella D, Havrilesky LJ, Burger RA, Monk BJ, Leath CA. Quality of life is significantly associated with survival in women with advanced epithelial ovarian cancer: An ancillary data analysis of the NRG Oncology/Gynecologic Oncology Group (GOG-0218) study. Gynecol Oncol 2017; 147:98-103. [PMID: 28743369 DOI: 10.1016/j.ygyno.2017.07.121] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 07/07/2017] [Accepted: 07/10/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Evaluate association between baseline quality of life (QOL) and changes in QOL measured by FACT-O TOI with progression-free disease (PFS) and overall survival (OS) in advanced epithelial ovarian cancer (EOC). METHODS Patients enrolled in GOG-0218 with completed FACT-O TOI assessments at baseline and at least one follow-up assessment were eligible. Baseline FACT-O TOI scores were sorted by quartiles (Q1-4) and outcomes compared between Q1 and Q2-4 with log-rank statistic and multivariate Cox regression adjusting for age, stage, post-surgical residual disease size, and performance status (PS). Trends in FACT-O TOI scores from baseline to the latest follow-up assessment were evaluated for impact on intragroup (Q1 or Q2-4) outcome by log-rank analysis. RESULTS Of 1152 eligible patients, 283 formed Q1 and 869 formed Q2-4. Mean baseline FACT-O TOI scores were 47.5 for Q1 vs. 74.7 for Q2-4 (P<0.001). Q1 compared to Q2-4 had worse median OS (37.5 vs. 45.6months, P=0.001) and worse median PFS (12.5 vs. 13.1months, P=0.096). Q2-4 patients had decreased risks of disease progression (HR 0.974, 95% CI 0.953-0.995, P=0.018), and death (HR 0.963, 95% CI 0.939-0.987, P=0.003) for each five-point increase in baseline FACT-O TOI. Improving versus worsening trends in FACT-O TOI scores were associated with longer median PFS (Q1: 12.7 vs. 8.6months, P=0.001; Q2-4: 16.7 vs. 11.1months, P<0.001) and median OS (Q1: 40.8 vs. 16months, P<0.001; Q2-4: 54.4 vs. 33.6months, P<0.001). CONCLUSIONS Baseline FACT-O TOI scores were independently prognostic of PFS and OS while improving compared to worsening QOL was associated with significantly better PFS and OS in women with EOC.
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Affiliation(s)
- N T Phippen
- Gynecologic Oncology Service, Department of Obstetrics and Gynecology, Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - A A Secord
- Division of Gynecologic Oncology, Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | - S Wolf
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA
| | - G Samsa
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA
| | - B Davidson
- Division of Gynecologic Oncology, Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | - A P Abernethy
- Duke Clinical Research Institute, Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | - D Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Robert H. Lurie Cancer Center, Chicago, IL, USA
| | - L J Havrilesky
- Division of Gynecologic Oncology, Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | - R A Burger
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - B J Monk
- Arizona Oncology (US Oncology Network), University of Arizona, Phoenix, AZ, USA; Creighton University, USA
| | - C A Leath
- University of Alabama at Birmingham, Division of Gynecologic Oncology, Birmingham, AL, USA.
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Climent M, Munarriz M, Blazeby JM, Dorcaratto D, Ramón JM, Carrera MJ, Fontane L, Grande L, Pera M. Weight loss and quality of life in patients surviving 2 years after gastric cancer resection. Eur J Surg Oncol 2017; 43:1337-1343. [PMID: 28222970 DOI: 10.1016/j.ejso.2017.01.239] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 11/28/2016] [Accepted: 01/24/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Malnutrition is common in patients undergoing gastric cancer resection, leading to weight loss, although little is known about how this impacts on health-related quality of life (HRQL). This study aimed to explore the association between HRQL and weight loss in patients 2 years after curative gastric cancer resection. METHODS Consecutive patients undergoing curative gastric cancer resection and surviving at least 2 years without disease recurrence were recruited. Patients completed the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and the specific module for gastric cancer (STO22) before and 2 years postoperatively and associations between HRQL scores and patients with and without ≥ 10% body weight loss (BWL) were examined. RESULTS A total of 76 patients were included, of whom 51 (67%) had BWL ≥10%. At 2 years postoperatively, BWL ≥10% was associated with deterioration of all functional aspects of quality of life, with persistent pain (21.6%), diarrhoea (13.7%) and nausea/vomiting (13.7%). By contrast, none of the patients with BWL <10% experienced severe nausea/vomiting, pain or diarrhoea. CONCLUSIONS Disabling symptoms occurred more frequently in patients with ≥10% BWL than in those with <10% BWL, with a relevant negative impact on HRQL. A cause-effect relationship between weight loss and postoperative outcome remains unsolved.
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Affiliation(s)
- M Climent
- Section of Gastrointestinal Surgery, Hospital Universitari del Mar, IMIM (Hospital del Mar Medical Research Institute), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M Munarriz
- Section of Gastrointestinal Surgery, Hospital Universitari del Mar, IMIM (Hospital del Mar Medical Research Institute), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J M Blazeby
- School of Social and Community Medicine, University of Bristol, and University Hospital Bristol National Health Services Foundation Trust, Bristol, UK
| | - D Dorcaratto
- Section of Gastrointestinal Surgery, Hospital Universitari del Mar, IMIM (Hospital del Mar Medical Research Institute), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J M Ramón
- Section of Gastrointestinal Surgery, Hospital Universitari del Mar, IMIM (Hospital del Mar Medical Research Institute), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M J Carrera
- Nutrition Unit, Service of Endocrinology, Hospital Universitari del Mar, Barcelona, Spain
| | - L Fontane
- Nutrition Unit, Service of Endocrinology, Hospital Universitari del Mar, Barcelona, Spain
| | - L Grande
- Section of Gastrointestinal Surgery, Hospital Universitari del Mar, IMIM (Hospital del Mar Medical Research Institute), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M Pera
- Section of Gastrointestinal Surgery, Hospital Universitari del Mar, IMIM (Hospital del Mar Medical Research Institute), Universitat Autònoma de Barcelona, Barcelona, Spain.
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Baker KM, DeSanto-Madeya S, Banzett RB. Routine dyspnea assessment and documentation: Nurses' experience yields wide acceptance. BMC Nurs 2017; 16:3. [PMID: 28100958 PMCID: PMC5237543 DOI: 10.1186/s12912-016-0196-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 12/12/2016] [Indexed: 01/27/2023] Open
Abstract
Background Dyspnea (breathing discomfort) is a common and distressing symptom. Routine assessment and documentation can improve management and relieve suffering. A major barrier to routine dyspnea documentation is the concern that it will have a deleterious effect on nursing workflow and that it will not be readily accepted by nurses. Nurses at our institution recently began to assess and document dyspnea on all medical-surgical patients upon admission and once per shift throughout their hospitalization. A year after dyspnea measurement was implemented we explored nurses’ approach to dyspnea assessment, their perception of patient response, and their perception of the utility and burden of dyspnea measurement. Methods We obtained feedback from nurses using a three-part assessment of practice: 1) a series of recorded focus group interviews with nurses, 2) a time-motion observation of nurses performing routine dyspnea and pain assessment, and 3) a randomized, anonymous on-line survey based, in part, on issues raised in focus groups. Results Ninety-four percent of the nurses surveyed reported administering the dyspnea assessment is “easy” or “very easy”. None of the nurses reported that assessing dyspnea negatively impacted workflow and many reported that it positively improved their practice by increasing their awareness. Our time-motion data showed dyspnea assessment and documentation takes well less than a minute. Nurses endorsed the importance of routine measurement and agreed that most patients were able to provide a meaningful rating of their dyspnea. Nurses found the patient report very useful, and used it in conjunction with observed signs to respond to changes in a patient’s condition. Conclusions In this study, we have demonstrated that routine dyspnea assessment and documentation was widely accepted by the nurses at our institution. Our nurses fully incorporated routine dyspnea assessment and documentation into their practice and felt that it improved patient-centered care. Electronic supplementary material The online version of this article (doi:10.1186/s12912-016-0196-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kathy M Baker
- Lois E. Silverman Department of Nursing, Beth Israel Deaconess Medical Center, 330 Brookline Avenue Reisman 1113, Boston, MA 02215 USA
| | - Susan DeSanto-Madeya
- Lois E. Silverman Department of Nursing, Beth Israel Deaconess Medical Center, 330 Brookline Avenue Reisman 1113, Boston, MA 02215 USA ; Connell School of Nursing, Boston College, Chestnut Hill, MA USA
| | - Robert B Banzett
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA USA ; Harvard Medical School, Boston, MA USA
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Carrillo J, Carrillo L, Ramirez-Ortega M, Ochoa-Carrillo F, Oñate-Ocaña L. The impact of treatment on quality of life of patients with head and neck cancer and its association with prognosis. Eur J Surg Oncol 2016; 42:1614-21. [DOI: 10.1016/j.ejso.2016.05.037] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 03/25/2016] [Accepted: 05/26/2016] [Indexed: 01/17/2023] Open
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Backemar L, Wikman A, Djärv T, Johar A, Lagergren P. Co-morbidity after oesophageal cancer surgery and recovery of health-related quality of life. Br J Surg 2016; 103:1665-1675. [PMID: 27545978 DOI: 10.1002/bjs.10248] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 03/22/2016] [Accepted: 05/23/2016] [Indexed: 11/12/2022]
Abstract
BACKGROUND Although health-related quality of life (HRQoL) recovers after surgery for oesophageal cancer in most long-term survivors, one in seven patients experiences a deterioration in HRQoL for reasons yet unknown. The aim of this study was to assess whether co-morbidities diagnosed after surgery influence recovery of HRQoL. METHODS Patients who underwent surgery for cancer of the oesophagus or gastro-oesophageal junction in Sweden between 2001 and 2005 were included. HRQoL was assessed by means of the European Organization for Research and Treatment of Cancer QLQ-C30 and QLQ-OES18 questionnaires. Repeated-measures ANOVA was used to assess mean differences in HRQoL scores between three co-morbidity status groups (healthy, stable and increased) over time. Probabilities of deterioration in HRQoL were calculated based on marginal probabilities from logistic regression models. RESULTS At 5 years' follow-up, 153 (24·8 per cent) of 616 patients were alive and 137 responded to at least two of three questionnaires. The healthy and increased co-morbidity groups showed deterioration in almost all aspects of HRQoL at 6 months after surgery compared with baseline. The increased co-morbidity group also deteriorated in several aspects from 3 to 5 years after surgery. Patients with an increase in co-morbidity did not have a significantly increased probability of deterioration in HRQoL over time compared with healthy or stable patients, except with respect to cognitive function, loss of appetite, choking and coughing. CONCLUSION Patients with an increase in co-morbidities after oesophagectomy experience long-term deterioration in HRQoL.
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Affiliation(s)
- L Backemar
- Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.
| | - A Wikman
- Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - T Djärv
- Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.,Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - A Johar
- Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - P Lagergren
- Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
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Kidane B, Sulman J, Xu W, Kong Q, Wong R, Knox JJ, Darling GE. Pretreatment quality-of-life score is a better discriminator of oesophageal cancer survival than performance status. Eur J Cardiothorac Surg 2016; 51:148-154. [DOI: 10.1093/ejcts/ezw264] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 06/14/2016] [Accepted: 06/27/2016] [Indexed: 11/13/2022] Open
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Kidane B, Sulman J, Xu W, Kong QQ, Wong R, Knox JJ, Darling GE. Baseline measure of health-related quality of life (Functional Assessment of Cancer Therapy-Esophagus) is associated with overall survival in patients with esophageal cancer. J Thorac Cardiovasc Surg 2016; 151:1571-80. [DOI: 10.1016/j.jtcvs.2016.01.052] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 12/29/2015] [Accepted: 01/17/2016] [Indexed: 11/16/2022]
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Affiliation(s)
- Robert B Banzett
- 1 Division of Pulmonary, Critical Care & Sleep Medicine Beth Israel Deaconess Medical Center Boston, Massachusetts and.,2 Department of Medicine Harvard Medical School Boston, Massachusetts
| | - Richard M Schwartzstein
- 1 Division of Pulmonary, Critical Care & Sleep Medicine Beth Israel Deaconess Medical Center Boston, Massachusetts and.,2 Department of Medicine Harvard Medical School Boston, Massachusetts
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Stevens JP, Baker K, Howell MD, Banzett RB. Prevalence and Predictive Value of Dyspnea Ratings in Hospitalized Patients: Pilot Studies. PLoS One 2016; 11:e0152601. [PMID: 27070144 PMCID: PMC4829144 DOI: 10.1371/journal.pone.0152601] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 03/16/2016] [Indexed: 11/18/2022] Open
Abstract
Background Dyspnea (breathing discomfort) can be as powerfully aversive as pain, yet is not routinely assessed and documented in the clinical environment. Routine identification and documentation of dyspnea is the first step to improved symptom management and it may also identify patients at risk of negative clinical outcomes. Objective To estimate the prevalence of dyspnea and of dyspnea-associated risk among hospitalized patients. Design Two pilot prospective cohort studies. Setting Single academic medical center. Patients Consecutive patients admitted to four inpatient units: cardiology, hematology/oncology, medicine, and bariatric surgery. Measurements In Study 1, nurses documented current and recent patient-reported dyspnea at the time of the Initial Patient Assessment in 581 inpatients. In Study 2, nurses documented current dyspnea at least once every nursing shift in 367 patients. We describe the prevalence of burdensome dyspnea, and compare it to pain. We also compared dyspnea ratings with a composite of adverse outcomes: 1) receipt of care from the hospital’s rapid response system, 2) transfer to the intensive care unit, or 3) death in hospital. We defined burdensome dyspnea as a rating of 4 or more on a 10-point scale. Results Prevalence of burdensome current dyspnea upon admission (Study 1) was 13% (77 of 581, 95% CI 11%-16%). Prevalence of burdensome dyspnea at some time during the hospitalization (Study 2) was 16% (57 of 367, 95% CI 12%-20%). Dyspnea was associated with higher odds of a negative outcome. Conclusions In two pilot studies, we identified a significant symptom burden of dyspnea in hospitalized patients. Patients reporting dyspnea may benefit from a more careful focus on symptom management and may represent a population at greater risk for negative outcomes.
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Affiliation(s)
- Jennifer P. Stevens
- Center for Healthcare Delivery Science, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
- Department of Medicine, Division for Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
| | - Kathy Baker
- Department of Nursing, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Michael D. Howell
- Department of Medicine, Section of Pulmonary and Critical Care, University of Chicago, Chicago, Illinois, United States of America
- Center for Healthcare Delivery Science and Innovation, University of Chicago, Chicago, Illinois, United States of America
| | - Robert B. Banzett
- Department of Medicine, Division for Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
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Cartwright J, Forbat E, Botha A. Ivor-Lewis oesophagogastrectomy with Roux-en-Y duodenal bypass. Ann R Coll Surg Engl 2016; 98:116-20. [PMID: 26741669 PMCID: PMC5210470 DOI: 10.1308/rcsann.2016.0009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2015] [Indexed: 11/22/2022] Open
Abstract
Oesophagectomies and gastrectomies are performed predominantly for the treatment of malignant disease. However, in this case series, we describe three patients with benign disease who had a laparoscopic oesophagogastrectomy with gastroduodenal detachment and Roux-en-Y biliary diversion, and discuss the operative feasibility and consequent patient outcomes. Our aim was to modify the procedure using an established reconstruction already practised in gastric and bariatric surgery, thereby preventing operative sequelae that lead to a poor quality of life (eg reflux oesophagitis and vomiting). During the first postoperative year, our first two patients experienced weight loss, indigestion and lower bowel symptoms with no apparent improvement in gastric function compared with a standard gastric tube pull-up reconstruction. In the longer term, in both patients, the gastric tube interpositions appeared to function well and there was no evidence of gastro-oesophageal reflux disease, delayed gastric emptying or troublesome indigestion. Our third patient, who had lifelong severe reflux symptoms, was eating normally three months after the operation with no need for antacid medication. We therefore conclude that laparoscopic Ivor-Lewis oesophagogastrectomy with Roux-en-Y bypass is a more complex reconstruction with added risks but may in the long term result in better overall outcomes and satisfaction for patients, particularly those with benign disease.
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Affiliation(s)
| | - E Forbat
- Guy's and St Thomas' NHS Foundation Trust , UK
| | - A Botha
- Guy's and St Thomas' NHS Foundation Trust , UK
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Prognostic value of health-related quality of life for overall survival in elderly non-small-cell lung cancer patients. Eur J Cancer 2016; 52:120-8. [DOI: 10.1016/j.ejca.2015.10.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 09/20/2015] [Accepted: 10/04/2015] [Indexed: 11/19/2022]
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Hauser C, Patett C, von Schoenfels W, Heits N, Schafmayer C, Malchow B, Hampe J, Schniewind B, Becker T, Egberts JH. Does neoadjuvant treatment before oncologic esophagectomy affect the postoperative quality of life? A prospective, longitudinal outcome study. Dis Esophagus 2015; 28:652-9. [PMID: 25059631 DOI: 10.1111/dote.12257] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
To evaluate the cancer patients' quality of life (QoL) following esophagectomy the focus was placed on the impact of neoadjuvant treatment before surgery. For patients undergoing oncologic surgery, the QoL is generally accepted as an important outcome parameter in addition to clinical parameters. This prospective nonrandomized study evaluated QoL in patients treated by preoperative chemo(radio)therapy followed by either surgery or surgery alone with special focus on the postoperative course. QoL was assessed in 131 consecutive patients who underwent surgery for esophageal cancer. The EORTC-QLQ-C30 and a tumor-specific module were administered before surgery, at discharge, 3, 6, 12, and 24 months after surgery. Clinical data were collected prospectively and a follow up was performed every 6 months. The histological type of cancer was squamous cell carcinoma in 49.6% and adenocarcinoma in 50.4%. There was no significant difference between patients that were treated neoadjuvantly and those that were first operated on with regard to morbidity, mortality, and survival rates (5-year survival rate of 34%). Most QoL scores dropped significantly below the baseline in the early postoperative period and recovered slowly during the follow-up period to almost preoperative levels in many scores. There was no statistically significant difference in any of the QoL scales between neoadjuvantly treated or primary operated patients. Esophageal resections are associated with significant deterioration of QoL, which slowly recovers during the follow-up period to an almost preoperative level. Neoadjuvant treatment seems to not further negatively affect the QoL deterioration.
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Affiliation(s)
- C Hauser
- Department of General Surgery and Thoracic Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - C Patett
- Department of General Surgery and Thoracic Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - W von Schoenfels
- Department of General Surgery and Thoracic Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - N Heits
- Department of General Surgery and Thoracic Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - C Schafmayer
- Department of General Surgery and Thoracic Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - B Malchow
- Reference Center for Quality of Life, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - J Hampe
- Department of Internal Medicine, Carl Gustav Carus University Hospital, Dresden, Germany
| | - B Schniewind
- Department of General Surgery and Thoracic Surgery, Städtisches Klinikum, Lüneburg, Germany
| | - T Becker
- Department of General Surgery and Thoracic Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - J-H Egberts
- Department of General Surgery and Thoracic Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Germany
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Rees JR, Rees M, McNair AGK, Odondi L, Metcalfe C, John T, Welsh FK, Blazeby JM. The Prognostic Value of Patient-Reported Outcome Data in Patients With Colorectal Hepatic Metastases Who Underwent Surgery. Clin Colorectal Cancer 2015; 15:74-81.e1. [PMID: 26341412 DOI: 10.1016/j.clcc.2015.07.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 07/20/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Patient-reported outcomes (PROs) are critical to evaluate clinically effective treatments and evidence suggests that PROs might predict survival. The prognostic value of PROs in patients with isolated liver metastases from colorectal cancer (CRC) who undergo surgery is unclear. In this study we investigated whether baseline PROs are prognostic in this patient group. PATIENTS AND METHODS From April 2004 to May 2007, consecutive patients who underwent curative resection of CRC liver metastases completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (QLQ)-C30 and QLQ-LMC21 questionnaires before surgery. Patients were followed until death or data were censored on April 9, 2012. Cox proportional hazards models were used to assess the effect of PROs on survival controlling for predefined clinical covariates. Models were simplified using a backwards stepwise approach and model utility appraised using the Harrell C and Somers D statistics and bootstrap methods. RESULTS Two hundred thirty-two patients underwent liver resection and 101 (43.5%) survived 5 years. Multivariate analysis controlling for relevant clinical covariates showed that a 10-point improvement in baseline global quality of life scores was associated with a 54% improvement in survival (hazard ratio [HR], 0.46; 95% confidence interval [CI], 0.33-0.63; P < .001), and a clinically significant weight loss was associated with 75% worse survival (HR, 1.75; 95% CI, 1.20-2.55; P = .004). Smaller effects were noted for worsening abdominal pain, taste problems, and fatigue (30%-38% poorer survival). Results of bootstrap resampling suggested that global health and weight loss most reliably predicted survival. CONCLUSION Results of this study demonstrated that patients who reported worse baseline global quality of life and increased weight loss before liver resection for CRC liver metastases had significantly poorer survival. These findings if externally validated might be used to inform patients, and could also influence treatment planning and advise follow-up strategies and supportive care.
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Affiliation(s)
- Jonathan R Rees
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom; Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom.
| | - Myrddin Rees
- Department of Hepatobiliary Surgery, Hampshire Hospitals Foundation Trust, Basingstoke, Hampshire, United Kingdom
| | - Angus G K McNair
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Lang'o Odondi
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Chris Metcalfe
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Timothy John
- Department of Hepatobiliary Surgery, Hampshire Hospitals Foundation Trust, Basingstoke, Hampshire, United Kingdom
| | - Fenella K Welsh
- Department of Hepatobiliary Surgery, Hampshire Hospitals Foundation Trust, Basingstoke, Hampshire, United Kingdom
| | - Jane M Blazeby
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom; Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
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Suk H, Kwon OK, Yu W. Preoperative Quality of Life in Patients with Gastric Cancer. J Gastric Cancer 2015; 15:121-6. [PMID: 26161285 PMCID: PMC4496438 DOI: 10.5230/jgc.2015.15.2.121] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 06/17/2015] [Accepted: 06/19/2015] [Indexed: 12/16/2022] Open
Abstract
Purpose We evaluated the socio-personal and clinical factors that can affect preoperative quality of life to determine how to improve preoperative quality of life in patients with gastric cancer. Materials and Methods The preoperative quality of life data of 200 patients (68 females and 132 males; mean age 58.9±12.6 years) with gastric cancer were analyzed according to socio-personal and clinical factors. The Korean versions of the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core (QLQ) 30 and the EORTC QLQ-STO22, a gastric cancer-specific module, were used to assess quality of life. Patients were asked to complete the questionnaire preoperatively by themselves. Results Patients with a higher academic background and stage I disease tended to have higher global health status scores. Highly educated younger men had better physical functioning scores. Highly educated and well-nourished patients with stage I cancer had higher role functioning scores. Married patients had better emotional scores. The symptom scales were affected by sex, age, education level, nutrition, and cancer stage. Conclusions Preoperative quality of life in patients with gastric cancer can be improved by nutritional support and treatment of symptoms caused by disease progression. Psychological support may be helpful for patients with a poor quality of life.
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Affiliation(s)
- Hyoam Suk
- Department of Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Oh Kyung Kwon
- Gastric Cancer Center, Kyungpook National University Medical Center, Daegu, Korea
| | - Wansik Yu
- Gastric Cancer Center, Kyungpook National University Medical Center, Daegu, Korea
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Fiteni F, Pam A, Anota A, Vernerey D, Paget-Bailly S, Westeel V, Bonnetain F. Health-related quality-of-life as co-primary endpoint in randomized clinical trials in oncology. Expert Rev Anticancer Ther 2015; 15:885-91. [DOI: 10.1586/14737140.2015.1047768] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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La qualité de vie relative à la santé dans les essais cliniques de phase III en oncologie : de l’administration du questionnaire à l’analyse statistique. Bull Cancer 2015; 102:360-6. [DOI: 10.1016/j.bulcan.2015.02.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 02/24/2015] [Indexed: 01/22/2023]
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Dietary alterations and restrictions following surgery for upper gastrointestinal cancers: Key components of a health-related quality of life intervention. Eur J Oncol Nurs 2015; 19:343-8. [PMID: 25697545 DOI: 10.1016/j.ejon.2015.01.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 01/14/2015] [Accepted: 01/22/2015] [Indexed: 12/31/2022]
Abstract
PURPOSE The surgical treatment of upper gastrointestinal (GI) cancers, specifically esophageal and gastric cancers, often result in extensive health-related quality of life (HRQOL) concerns, particularly those associated with dietary adjustments. This paper provides a review of HRQOL changes following esophagectomy and gastrectomy, and describes key components of an intervention to improve dietary adjustments following surgery. METHODS Intervention development was informed by 1) current published evidence on HRQOL changes for patients following upper GI surgery, 2) examination of usual post-operative care related to dietary restrictions to identify areas for continued education and support and 3) the inclusion of a conceptual framework (the Chronic Care Model) to guide intervention design and inform the selection of appropriate outcome measures. RESULTS Three key components of an HRQOL intervention are identified, and should focus on HRQOL concerns associated with dietary alterations and restrictions following treatment, involve family caregivers, and be tailored and flexible to patient and family caregiver's needs and preferences. CONCLUSIONS Evidence-based interventions to support long-term dietary alterations and restrictions following upper GI surgery are lacking, despite evidence confirming its impact on morbidity and mortality. Interventions are needed to support dietary adjustments, prevent malnutrition and excessive weight loss, and enhance HRQOL following surgery for upper GI cancers.
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Affiliation(s)
- Robert B Banzett
- Dept of Medicine, Harvard Medical School, Boston, MA, USA Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Carl R O'Donnell
- Dept of Medicine, Harvard Medical School, Boston, MA, USA Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Chang D, Church J. Evaluating the health-related quality of life of esophageal cancer patients. Pract Radiat Oncol 2014; 4:181-186. [DOI: 10.1016/j.prro.2013.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 06/05/2013] [Accepted: 07/10/2013] [Indexed: 11/27/2022]
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Djärv T, Derogar M, Lagergren P. Influence of co-morbidity on long-term quality of life after oesophagectomy for cancer. Br J Surg 2014; 101:495-501. [PMID: 24474187 DOI: 10.1002/bjs.9417] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2013] [Indexed: 11/12/2022]
Abstract
BACKGROUND The extent to which co-morbidities affect recovery of health-related quality of life (HRQoL) in long-term survivors of oesophageal cancer surgery is poorly understood. METHODS This was a prospective, population-based, nationwide Swedish cohort study of patients who underwent surgery for oesophageal cancer between 2001 and 2005, and were alive 5 years after operation. The European Organization for Research and Treatment of Cancer QLQ-C30 and the QLQ-OES18 questionnaires were used to assess HRQoL up to 5 years after surgery. Eight aspects from the questionnaires were selected. Matched reference values from the Swedish general population were used as a proxy for HRQoL before presentation of the cancer. Adjusted multivariable linear mixed-effect models were used to assess mean score differences (MDs) of each HRQoL aspect in patients with or without co-morbidities. RESULTS Of 616 patients who underwent surgery, 153 (24·8 per cent) survived 5 years, of whom 141 (92·2 per cent) completed the questionnaires at 5 years. Among these, 79 (56·0 per cent) had co-morbidities. Patients with co-morbidity had clinically relevant (MD at least 10) and statistically significantly poorer global quality of life (MD -10, 95 per cent confidence interval -12 to -7), and more problems with dyspnoea (MD 10, 6 to 13) throughout the whole follow-up period than those without co-morbidity. Patients with co-morbidity had a clinically relevant worse level of fatigue at 6 months (MD 10, 1 to 19) and 5 years (14, 4 to 24). With regard to specific co-morbidities, only patients with diabetes reported more clinically relevant, but not statistically significant, problems with fatigue at 6 months (MD 16, 2 to 31) and 5 years (MD 13, -5 to 31) compared with patients without co-morbidity. CONCLUSION Among survivors of oesophageal cancer surgery, the presence of co-morbidity was associated with poor HRQoL over time and increasing symptoms of fatigue.
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Affiliation(s)
- T Djärv
- Unit of Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institute, Norra Stationsgatan 67, Level 2, SE-171 76, Stockholm, Sweden
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Abstract
Dyspnea assessment is valuable in diagnosis, prognosis, symptom management, and targeted intervention, and in the allotment and management of patient care resources. The assessment of dyspnea, like that of pain, depends on patient self-report. Expert consensus panels have called for dyspnea to be measured quantitatively and documented on a routine basis, as is the practice with pain. But little information is available on how to measure and record dyspnea ratings systematically. Consequently, the prevalence of dyspnea in hospital settings may be greater than is generally recognized, and dyspnea may be insufficiently managed. This article describes a pilot study that sought to test the feasibility of measuring dyspnea as part of the initial patient assessment performed by nurses within several inpatient units of a large urban hospital.
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Wikman A, Johar A, Lagergren P. Presence of symptom clusters in surgically treated patients with esophageal cancer: Implications for survival. Cancer 2013; 120:286-93. [DOI: 10.1002/cncr.28308] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Anna Wikman
- Unit of Upper Gastrointestinal Research; Department of Molecular Medicine and Surgery; Karolinska Institute; Stockholm Sweden
| | - Asif Johar
- Unit of Upper Gastrointestinal Research; Department of Molecular Medicine and Surgery; Karolinska Institute; Stockholm Sweden
| | - Pernilla Lagergren
- Unit of Upper Gastrointestinal Research; Department of Molecular Medicine and Surgery; Karolinska Institute; Stockholm Sweden
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