Health-related quality of life after esophagectomy in patients with esophageal cancer

Health-related quality of life and related factors among esophageal cancer survivors after esophagectomy in the 6-month postoperative period: A multicenter cross-sectional study in north China

Objective

Esophagectomy is a primary curable treatment and a highly challenging procedure for esophageal cancer (EC) survivors. EC survivors experience various unmet needs. This study is aimed to assess unmet needs, health-related quality of life (HRQOL), and psychological distress of postoperative EC survivors.

Methods

A multicenter cross-sectional study was conducted between December 2023 and March 2024 across 28 hospitals in northern China. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, Hospital Anxiety and Depression Scale, and Supportive Care Need Survey - Short Form 34 were utilized to assess the HRQOL, anxiety, depression, and unmet needs.

Results

A total of 357 postoperative EC survivors were recruited, with a mean age of 63.42 years. Approximately 14.6% exhibited borderline anxiety, and 17.9% showed borderline depression. Unmet needs were highest in health information and patient care domains. HRQOL was lower in global health, social, and physical functions post-surgery. Fatigue, appetite loss, insomnia, and financial difficulties were common. Dysphagia, dry mouth, reflux, and choking negatively impacted HRQOL. Multivariable regression analysis indicated that anxiety and depression levels were higher, and HRQOL was lower in those one week to six months post-surgery compared to one-week post-surgery.

Conclusions

EC survivors experience significant psychological distress and reduced HRQOL up to six months post-surgery. Dysphagia and unmet needs are prevalent. Compared to immediate post-surgery, EC survivors experienced higher levels of anxiety and depression, and lower level of HRQOL in six months. Future research should focus on developing individualized care strategies to provide optimal support.

Effect of psychological intervention combined with feedback-based health education on lung cancer patients

OBJECTIVE

To explore the application effect of Psychological Intervention based on the emotional adaptation theory combined with Feedback-based Health Education (PICFHE) on lung cancer patients.

METHOD

A total of 216 lung cancer patients were divided into a control group and an observation group using a random number table method. The control group received routine nursing intervention, while the observation group received PICFHE on the basis of the control group. Psychological status was compared using the Self Rating Anxiety Scale (SAS) and Self Rating Depression Scale (SDS). Quality of life was measured using WHOQOL-BREF scale and the respiratory condition, satisfaction with the nursing staff, and incidence of adverse reactions were observed. Data were analyzed quantitatively using the software SPSS 20.0.

RESULTS

After intervention, scores of SAS and SDS, respiratory rate, and total incidence of adverse reactions in the observation group were significantly lower than those in the control group. After intervention, the level of maximum volume ventilation and the scores in all dimensions of the WHOQOL-BREF scale of the observation group were higher than those of the control group.

CONCLUSION

PICFHE can improve patients' psychological status, their quality of life and satisfaction with the nursing staff, and reduce the incidence of adverse reactions.

Developing a health education program for home enteral nutrition after esophageal cancer surgery based on the Delphi method

To develop a health education program for home enteral nutrition (HEN) after Esophageal cancer (EC) surgery based on Delphi method, providing reference opinions for clinical nursing education and patient home care. The health education program for HEN after EC surgery was constructed through literature research, theoretical analysis and group discussion. From February to June 2024, experts in clinical nursing, clinical medicine, and nutrition of EC were invited to conduct 2 rounds of Delphi expert consultation to initially determine the items of the program. The weight and assignment of each items were determined through analytic hierarchy process (AHP), and then the final health education program for HEN after EC surgery was established. The authoritative coefficients of the 2 rounds consulting experts were 0.918 and 0.929 and the positive coefficients were 100% and 95%, respectively; The mean range of importance assignment for the second round of consultation indicators was 4.26 to 5.00 points, with a full score range of 40.90% to 95.45%. The mean harmony coefficients for expert opinions from 2 rounds were 0.206 and 0.218 (P < .01), respectively. The final health education program for postoperative HEN in EC includes 6 primary items, 27 secondary items, and 18 tertiary items. The results of the AHP showed that the consistency coefficients (CR values) of each matrix for the tertiary items were all < 0.1, meeting the requirements of consistency testing. The constructed health education program for postoperative HEN patients with EC in this study has high scientific and practical value, and can provide reference for the health education of postoperative HEN patients with EC.

Global, regional, and national burden of esophageal cancer using the 2019 global burden of disease study

Esophageal cancer, with its aggressive nature and high mortality, poses diverse epidemiological challenges worldwide. Over the past three decades, esophageal cancer has exhibited a substantial global burden, marked by a significant increase in absolute numbers, contrasting with a decline in age-standardized metrics. Prevalence nearly doubled, reaching 0.961 million in 2019, while the age-standardized rate (ASR) decreased to 11.6 per 100,000 cases. New incidence cases surged by 67.07%, yet the age-standardized incidence rate reduced to 6.5 per 100,000 cases. Deaths increased to 0.498 million, with a decline in age-standardized mortality to 6.1 per 100,000 cases. Disability-Adjusted Life Years (DALYs) rose to 11.67 million, but the ASR decreased to 139.8 per 100,000 cases. Gender-specific analysis revealed consistently higher rates in males, with increasing gaps over time. Correlations with SDI indicated a negative association, and frontier analysis underscored the impact of socio-economic progress on disease control. Projections suggest a continued rise in prevalence, incidence, deaths, and DALYs, with gender-specific variations. The research underscores the importance of continued efforts in public health and medical research to adapt to and manage the changing landscape of esophageal cancer globally.

Survival outcomes of robot-assisted transmediastinal esophagectomy in patients with esophageal squamous cell carcinoma

We developed a robot-assisted transmediastinal esophagectomy (RATME) to reduce the surgical invasiveness of open transthoracic esophagectomy (oTTE). However, the long-term survival outcomes of patients who undergo RATME remain unclear. Patients who underwent RATME for esophageal squamous cell carcinoma (ESCC) between January 2012 and April 2020 were enrolled. Overall survival (OS), relapse-free survival (RFS), and ESCC cause-specific survival (CSS) were analyzed according to clinical stage. Survivals were compared between patients who underwent the RATME and oTTE using propensity score matching analysis. One hundred and twenty-seven patients who underwent RATME were included in the analysis. The 3- and 5-year OS rates were 96.2 and 92.1% for cStage I RATME group, 84.8 and 82.3% for cStage II, and 61.8 and 61.8% for cStage III, respectively. The 3- and 5-year RFS rates were 94.3 and 84.3% for cStageI, 71.7 and 69.3% for cStage II, and 5 48.2 and 48.2% for cStage III, respectively. Survival analysis using 74 paired patients showed that the RATME group had better OS and RFS than the oTTE group (p = 0.0028 and p = 0.016, respectively), but equivalent CSS (p = 0.078). The OS of the RATME group stratified by clinical stage was equivalent to that of the comprehensive registry data from Japan, and showed better OS and RFS than the oTTE group, indicating that RATME radicality is guaranteed with regard to long-term survival.

Lived experiences of dysphagia-related quality of life among esophageal cancer patients: a qualitative study

INTRODUCTION

Esophageal cancer impairs basic functions such as eating and drinking frequently resulting in difficulty swallowing (dysphagia) and other problems such as weight loss, pain, fatigue, and taste alterations. There is still a research gap in understanding the impact of dysphagia on quality of life, as patients continue to bear significant physical and psychological burdens despite advances in treatment. This study attempted to address this gap by examining the lived experiences of dysphagia-related quality of life among esophageal cancer patients.

METHODS

A phenomenological study was employed to analyze the data provided by 14 patients with esophageal cancer at the Oncology Center of the University of Gondar Comprehensive Specialized Hospital from March to April 2023. An interview guide was employed to carry out in-depth interviews with purposively selected patients. The interviews were audio-taped, translated, transcribed, and analysed using thematic analysis.

RESULTS

Three main themes emerged from the analysis of the participant interviews: physical challenges related to difficulty swallowing, altered dietary habits, and struggle to maintain weight; psychosocial strain, including emotional distress and social isolation; and reliance on assistance, encompassing both dependency and financial burden.

CONCLUSION AND RECOMMENDATIONS

This study underscores the significant physical, emotional, and social challenges experienced by esophageal cancer patients with dysphagia. To enhance support, healthcare providers should develop personalized care plans that address both the physical and emotional aspects of dysphagia, with sensitivity to cultural practices. Efforts should also be made to alleviate feelings of dependency and promote public awareness to reduce stigma and build a more supportive community.

Effects of Early Oral Feeding on Quality of Life Following Esophagectomy: A Systematic Review and Meta-Analysis

BACKGROUND

The role of early oral feeding (EOF) following esophagectomy remains debated. This study evaluates whether postoperative EOF improves patients' quality of life.

METHODS

A comprehensive search was performed across eight databases to identify relevant studies. The effects of continuous variables were assessed using the mean difference (MD). The effects of dichotomous variables were assessed using the relative risk (RR).

RESULTS

Seven studies were included in the analysis. EOF significantly improved postoperative overall quality of life [MD = 9.64, 95% CI (6.11, 13.16), p < 0.001], dysphagia [MD = -7.37, 95% CI (-14.32, -0.42), p = 0.040], and eating difficulty [MD = -6.72, 95% CI (-10.62, -2.82), p < 0.001]. However, no significant differences were observed in postoperative reflux [MD = -5.90, 95% CI (-12.52, 0.73), p = 0.080], esophageal pain [MD = -1.86, 95% CI (-5.51, 1.78), p = 0.320], anastomotic leakage [RR = 0.70, 95% CI (0.37, 1.35), p = 0.290], and pulmonary infection [RR = 0.44, 95% CI (0.15, 1.35), p = 0.150].

CONCLUSION

EOF after esophagectomy appears to improve patients' quality of life; however, these findings are constrained by the limited number and quality of studies. Further research is needed to validate these results.

Effect of Neoadjuvant Therapy on Endoluminal Vacuum-Assisted Closure Therapy (EVAC) for Anastomotic Leakage After Oesophagectomy

BACKGROUND

Anastomotic leakage (AL) is a dreaded complication after oesophagectomy. Endoluminal vacuum-assisted closure therapy (EVAC) has been increasingly used as a first-line treatment for AL. We aimed to identify any potential adverse effects of a neoadjuvant therapy (chemotherapy (CT) or radiochemotherapy (RCT)) on EVAC.

METHODS

We performed a retrospective cohort study at our tertiary centre between 2013 and 2024. All patients who underwent EVAC for AL after oesophagectomy were included in this study. Parameters such as success rate, length of therapy, number of sponges needed, changes in treatment, and survival were analysed.

RESULTS

A total of 29 patients were included, 19 of whom received CT/RCT and 10 of whom received no neoadjuvant treatment (NT). There was no significant difference in patient survival (30-day survival rate CT/RCT n = 1 (5.3%) vs. NT n = 1 (10%), p = 0.632), success rate (CT/RCT n = 15 (78.9%) vs. NT n = 9 (90%), p = 0.454), and length of therapy (CT/RCT vs. NT 24.11 vs. 23.8, p = 0.681), the number of sponges required (CT/RCT vs. NT 6.26 vs. 6.6, p = 0.835), and the need for changing treatment (CT/RCT n = 5 (26.3%) vs. NT n = 1 (10%), p = 0.303).

CONCLUSIONS

NT did not affect the success rate or length of therapy. Thus, we found no significant influence of CT/RCT on EVAC for AL after oesophagectomy.

Factors influencing quality of life in early-stage upper gastrointestinal cancer patients in Nanchong city: a qualitative study

OBJECTIVES

To identify the determinants of quality of life (QoL) among early-stage upper gastrointestinal cancer (UGIC) patients in Nanchong City to inform the development of targeted treatment plans.

METHODS

In this retrospective study, 642 patients diagnosed with UGIC were included. A phenomenological approach was employed, involving in-depth face-to-face interviews to explore patients' real-life experiences with QoL, with an emphasis on spiritual and psychological aspects. Data analysis followed Colaizzi's seven-step method. Statistical analyses included one-way Analysis of Variance (ANOVA), t-tests, binary logistic regression, and Pearson correlation tests.

RESULTS

QoL was significantly reduced in patients with early-stage GI cancer (P<0.001), with prevalent symptoms of anxiety and depression necessitating focused psychological interventions and enhanced medical care. Influential factors on QoL included income, health insurance coverage, illness duration, and levels of anxiety and depression (P<0.001). A strong negative correlation was observed between QoL scores and both the Hamilton Anxiety Scale (r=-0.7808, P<0.001) and the Hamilton Depression Rating Scale (r=-0.7493, P<0.001).

CONCLUSION

This study underscores the substantial impact of anxiety and depression on the QoL of patients with early-stage UGIC. The findings provide a theoretical basis for implementing comprehensive long-term care strategies.

Frailty and Health-Related Quality of Life in Elderly Patients Undergoing Esophageal Cancer Surgery: A Longitudinal Study

PURPOSE

This study aims to elucidate the longitudinal alterations in frailty and health-related quality of life experienced by elderly patients undergoing surgical treatment for esophageal cancer. Additionally, it seeks to ascertain the impact of preoperative frailty on postoperative health-related quality of life over time.

METHODS

131 patients were included in the prospective study. Patients' frailty and health-related quality-of-life were assessed utilizing the Tilburg and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 at preoperative, 1 week, 1 month, and 3 months, postoperatively. Statistical analyses were performed using generalized estimating equations, repeated-measures analysis of variance, and linear mixed models (LMMs).

RESULTS

Out of 131 patients, 28.2% had frailty before surgery, and the prevalence of frailty consistently higher after surgery compared with baseline (67.9%, 51.9%, and 39.7%). There was no significant change in frailty scores in preoperative frail patients within 3 months following surgery (p = .496, p < .999, p < .999); whereas in preoperative non-frail patients, the frailty scores increased at 1 week (p < .001) and then decreased at 1 month (p = .014), followed by no change at 3 months. In addition, preoperative frail patients had significantly worse global quality-of-life (β = -4.24 (-8.31; -.18), p = .041), physical functioning (β = -9.87 (-14.59; -5.16), p < .001), role functioning (β = -10.04 (-15.76; -4.33), p = .001), and social functioning (β = -8.58 (-15.49; -1.68), p = .015), compared with non-frail patients.

CONCLUSIONS

A significant proportion of participants exhibited a high prevalence of preoperative frailty. These patients, who were preoperatively frail, exhibited a marked reduction in health-related quality-of-life, a more gradual recovery across various functional domains, and an increased symptom burden during the follow-up period. Therefore, it is crucial to meticulously identify and closely monitor patients with preoperative frailty for any changes in their postoperative physiology, role, and social functioning.

Nature, severity, and impact of chronic oropharyngeal dysphagia following curative resection for esophageal cancer: a cross-sectional study

Chronic oropharyngeal dysphagia (COD) and aspiration after esophageal cancer surgery may have clinical significance; however, it is a rarely studied topic. In a prospective cross-sectional observational study we comprehensively evaluated the nature, severity, and impact of COD, its predictors, and the impact of the surgical approach and site of anastomosis. Forty participants were recruited via purposive sampling from the (Irish) National Center between November 2021 and August 2022. Swallow evaluations included videofluoroscopy [Dynamic Imaging Grade of Swallowing Toxicity v2 (DIGESTv2), MBS Impairment Profile, Penetration-Aspiration Scale)]. Functional Oral Intake Scale (FOIS) identified oral intake status. The patient reported outcome measures of swallowing, and Quality of Life (QL) included EAT-10 and MD Anderson Dysphagia Inventory (MDADI). Fourteen (35%) participants presented with COD on DIGESTv2 and 10% had uncleared penetration/aspiration. Avoidance or modification of diet on FOIS was observed in 17 (42.5%). FOIS was associated with pharyngeal dysphagia (OR = 4.05, P = 0.046). Median (range) EAT-10 and MDADI Composite results were 3(0-30) and 77.9(60-92.6), respectively. Aspiration rates significantly differed across surgical groups (P = 0.029); only patients undergoing transhiatal surgery aspirated. Survivors of esophageal cancer surgery may have COD that is undiagnosed, potentially impacting swallow-related QL. Given the small number of aspirators, further research is required to determine whether aspiration risk is associated with surgical approach. A FOIS score below 7 may be a clinically useful prompt for the MDT to refer for evaluation of COD following curative intent surgery. These data present findings that may guide preventive and rehabilitative strategies toward optimizing survivorship.

Effect of Intrathoracic or Cervical Anastomosis After Esophagectomy on Quality of Life

PURPOSE

We aimed to perform serial quality-of-life (QoL) evaluations and comparisons in patients after esophagectomy with intrathoracic anastomosis (IA) or cervical anastomosis (CA).

METHODS

Between November 2012 and March 2015, patients who underwent esophagectomy with IA or CA for mid-esophageal to distal esophageal or gastroesophageal junction cancer were followed up. QoL was measured using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (EORTC QLQ-C30) and esophagus-specific questionnaire (EORTC QLQ-OES18) before surgery, at discharge, and at 1, 6, 12, and 24 months after discharge. Linear mixed-effect models were used to assess the mean score differences (MDs) of each QoL scale between the two techniques, and changes in QoL over time. Potential confounders were adjusted.

RESULTS

In total, 219 patients were analyzed (IA, n = 127; CA, n = 92). All patients' QoL decreased immediately after esophagectomy. Global QoL and most functioning and symptom scales exhibited a return to baseline levels within 2 years of discharge, except for physical functioning and several symptoms (dyspnea, diarrhea, dysphagia, and reflux). There was no difference in overall health score between the two groups (MD 2, 95% confidence interval [CI] - 1 to 6). Compared with IA, patients with CA reported more trouble with taste (MD - 12, 95% CI - 19 to - 4) and talking (MD - 11, 95% CI - 19 to 2) at discharge. No differences in long-term QoL were found between groups.

CONCLUSIONS

CA was associated with more trouble with taste and talking in the short term than IA. The long-term QoL did not differ between the two approaches.

Association between healthy lifestyle factors and health-related quality of life among Chinese adolescents: the moderating role of gender

BACKGROUND

To examine the associations of the independent and combined healthy lifestyle factors with health-related quality of life (HRQOL) in adolescents, and to test the moderating role of gender.

METHODS

This cross-sectional study included 5125 adolescents aged between 11 and 20 years. They provided self-reported data on six healthy lifestyle factors, including never smoking, never drinking, good sleep quality, sufficient sleep duration, appropriate Internet use, and adequate physical activity. Adolescents' HRQOL was evaluated using the Pediatric Quality of Life Inventory version 4.0. Linear regression models were conducted to explore the association of individual and combined healthy lifestyle factors with adolescents' HRQOL. We further performed stratified analyses and likelihood ratio test to explore the moderating role of gender in these associations.

RESULTS

Of the included adolescents, the proportions with 0-2, 3, 4, and 5-6 healthy lifestyle factors were 13.6%, 26.4%, 44.3%, and 15.7%, respectively. Compared to adolescents with composite healthy lifestyle scores of 0-2, those with scores of 3, 4, or 5-6 had significantly higher HRQOL scores across all dimensions, summary scales, and total scale in both unadjusted and adjusted models. Specifically, adolescents with 5-6 healthy lifestyle factors had a total scale score that was 19.03 (95%CI: 17.76 to 20.30) points higher than their counterparts who only had 0-2 healthy lifestyle factors. Significant dose-response patterns were also observed in aforementioned associations. Gender was a significant moderator in the associations between composite healthy lifestyle groups and HRQOL scores, except for the social functioning dimension.

CONCLUSIONS

Our results confirmed that combined healthy lifestyle factors were associated with improved HRQOL among adolescents, with a stronger association observed in girls. These findings underscore the necessity for education and healthcare authorities to design health-promoting strategies that encourage multiple healthy lifestyle factors in adolescents, with the objective of enhancing their overall health outcomes.

Different gastric tubes in esophageal reconstruction during esophagectomy

Esophagectomy is currently the mainstay of treatment for resectable esophageal carcinoma. Gastric grafts are the first substitutes in esophageal reconstruction. According to the different tailoring methods applied to the stomach, gastric grafts can be classified as whole stomach, subtotal stomach and gastric tube. Gastric-tube placement has been proven to be the preferred method, with advantages in terms of postoperative complications and long-term survival. In recent years, several novel methods involving special-shaped gastric tubes have been proposed, which have further decreased the incidence of perioperative complications. This article will review the progress and clinical application status of different types of gastric grafts from the perspectives of preparation methods, studies of anatomy and perioperative outcomes, existing problems and future outlook.

Evaluation of a short instrument for measuring health-related quality of life in oncological patients in routine care (HELP-6): an observational study

Purpose

Patient-reported outcomes have not been sufficiently implemented into the routine care of cancer patients because the existing instruments are often too long and complex or not cancer-specific. The aim of this study is the determination of psychometric properties and item reduction of a newly developed health-related quality of life (HrQoL) questionnaire for use in oncological clinical routines.

Methods

This observational study with a repeated measurements design included oncological inpatients and outpatients. A total of 630 patients participated at the first point of measurement and 404 at the second point of measurement. To evaluate the instrument, we conducted hierarchical confirmative factor analyses and for further validation correlated the resulting factors with standardized and validated HrQoL measurements. Test-retest reliability and responsiveness to change were tested.

Results

The developed questionnaire "HELP-6" ("Hamburg Inventory for Measuring Quality of Life in Oncological Patients") has a six-factor structure and has moderate-to-good convergent validity (r= -0.25 --0.68). Test-retest reliability was moderate-to-good (r =0.56-0.81, p < 0.001). Indications for responsiveness to change were found for three dimensions. The final version of the questionnaire HELP-6 has six dimensions with one item each.

Conclusion

With the HELP-6 instrument for measuring HrQoL in cancer patients, we provide a short and practical patient-reported outcome instrument. Though responsiveness to change could not be confirmed for all dimensions in this study, the HELP-6 includes time-efficient completion and evaluation and is informative in relevant HrQoL dimensions of cancer patients. Therefore, the HELP-6 poses an important addition to inpatient and outpatient routine cancer care.

Trial registration

This study was registered at Open Science Framework (https://osf.io/y7xce/), on 9 June 2018.