Pilot Study of Patient Reported Outcomes in Patients with Esophageal Cancer following Esophagectomy

Exploring the relationship between postoperative psychological resilience and symptom burden in esophageal cancer patients

PURPOSE

Psychological resilience (PR) is an important internal resource for alleviating symptom burden in esophageal cancer surgery patients. However, the relationship between PR and symptom burden has not been explored to date. The primary purpose of this study is to determine the relationship between these two variables.

METHODS

This multi-center cross-sectional study analyzed data from 486 esophageal cancer surgery patients (2022-2024), assessing symptom burden and PR using the Convalescence Symptom Assessment Scale for Esophagectomy Patients and the Connor-Davidson Resilience Scale. Symptom burden was visualized with radar charts, and network analysis identified the relationship between PR and symptom burden.

RESULTS

Esophageal cancer patients experienced a significant symptom burden in the early postoperative period. Network analysis revealed that helplessness (Bridge Strength = 0.23), close and secure relationships (Bridge Strength = 0.21), disturbed sleep (Bridge Strength = 0.11), and pride in your achievements (Bridge Strength = 0.08) were bridge nodes connecting the combination network. Among these, helplessness was identified as a critical factor in initiating and sustaining the relationship between PR and symptom burden.

CONCLUSIONS

PR plays a crucial role in alleviating symptom burden. This study identifies the bridge nodes in the combination network of PR and symptom burden in esophageal cancer patients. Implementing interventions targeting these factors may enhance the precision and effectiveness of symptom management.

Long-term patient-reported outcomes after non-small cell lung cancer resection

OBJECTIVES

Patient-reported outcomes (PROs) are critical tools for evaluating patients before and after lung cancer resection. In this study, we assessed patient-reported pain, dyspnea, and functional status up to 1 year postoperatively.

METHODS

This study included patients who underwent surgery for non-small cell lung cancer at a single institution (2017-2020). We collected PROs using the National Institutes of Health Patient Reported Outcome Measurement Information System (PROMIS). Data were prospectively collected and merged with our institutional Society of Thoracic Surgeons data. Using multivariable linear mixed effect models, we compared PROMIS scores for preoperative and several postoperative visits.

RESULTS

From 2017 until 2020, 334 patients underwent lung cancer resection with completed PROMIS assessments. Pain interference, physical function, and dyspnea severity scores were worse 1 month after surgery (P < .001). Pain interference and physical function scores returned to baseline by 6 months after surgery. However, dyspnea severity scores remained persistently worse up to 1 year after surgery (1-month difference, 8.8 ± 1.9; 6-month difference, 3.6 ± 2.2; 1-year difference, 4.9 ± 2.8; P < .001). Patients who received a thoracotomy had worse physical function and pain interference scores 1 month after surgery compared with patients who received a minimally invasive operation; however, there were no differences in PROs by 6 months after surgery.

CONCLUSIONS

PROs are important metrics for assessing patients before and after lung cancer resection. Patients may report persistent dyspnea up to 1 year after resection. Additionally, patients undergoing thoracotomy initially report worse pain and physical function but these impairments improve by 6 months after surgery.