Health-related quality-of-life assessment in gastrointestinal cancer: are results relevant for clinical practice?

Changes in the nutritional status of elderly patients after esophagectomy

BACKGROUND

Esophagectomy is a highly invasive procedure for patients aged > 70 years. Here, we compared the actual nutritional status of older and younger patients who underwent esophagectomy.

METHODS

A total of 118 patients who underwent radical esophagectomy between April 2013 and December 2016 were enrolled and divided into two groups based on age: group A (n = 41; ≥ 70 years) and group B (n = 77; < 70 years). Data pertaining to body mass index and nutritional variables (albumin; total cholesterol; cholinesterase; and prealbumin) were retrospectively analyzed preoperatively and at 3, 6, and 12 months postoperatively.

RESULTS

Significant preoperative between-group differences were found in the cholinesterase, albumin, and prealbumin levels. The body mass index gradually decreased over the first 12 months after surgery in both groups, without significant between-group differences. Significant differences were observed in prealbumin and cholinesterase levels at 3 months postoperatively. 1 year postoperatively, both groups showed slight improvements; however, the between-group differences were not statistically significant. Group A had a significantly lower amount of the degree of decrement of BMI and chE than group B.

CONCLUSION

Thus, patients aged > 70 years can recover within 12 months of esophagectomy.

Long-term nutrition intervention following major upper gastrointestinal surgery: a prospective randomized controlled trial

BACKGROUND/OBJECTIVES

Nutritional status has been shown to affect quality of life, tolerance of future treatments and survival in people having undergone major upper gastrointestinal surgery. The objective of this trial was to assess the impact of intense individualized dietary advice following major upper gastrointestinal surgery on nutritional status, dietary intake, gastrointestinal symptoms and quality of life, compared to the current usual care.

SUBJECTS/METHODS

On discharge from hospital, people having had major upper gastrointestinal surgery were randomized to have dietetic follow-up fortnightly for 6 months or to a control group. Data collection was conducted at baseline, and at 1, 3 and 6 months.

RESULTS

Twenty-seven people were randomized to either the intervention or control group. There was a small but non-significant difference in percent weight loss in the intervention (-0.8 ± 8.8) compared to the control group (-2.7 ± 9.7) at 6 months. There were no other differences between the two groups.

CONCLUSIONS

This small study did not demonstrate that intense individualized dietary advice leads to improvements in nutritional status and quality of life for people having had major upper gastrointestinal surgery. The study does highlight that this group is at high nutritional risk, and does support the need for a larger multicentre study.

Validation of the functional assessment of cancer therapy-gastric module for the Chinese population

Background

Quality of life (QoL) assessment has become an important aspect of the clinical management of gastric cancer (GC), which poses a greater health threat in Chinese populations around the world. Functional Assessment of Cancer Therapy-Gastric Module (FACT-Ga), a questionnaire developed specifically to measure QoL of patients with GC, has never been validated in Chinese subjects. The current study was designed to examine the psychometric properties of FACT-Ga as a GC specific QoL instrument for its future use in Chinese populations.

Methods

A sample of 67 Chinese patients with GC in the National University Hospital, Singapore was investigated cross-sectionally. The participants independently completed either English or Chinese versions of the FACT-Ga and the European Quality of Life-5 Dimensions (EQ-5D). Reliability was measured as the Cronbach’s α for EQ-5D, and five subscale scores and two total scores of FACT-Ga. The sensitivity to patients’ clinical status was evaluated by comparing EQ-5D and FACT-Ga scores between clinical subgroups classified by Clinical Stage and Treatment Intent. The construct validity of FACT-Ga was assessed internally by examining the item-to-scale correlations and externally by contrasting the FACT-Ga subscales with the EQ-5D domains.

Results

For both FACT-Ga and EQ-5D, patients treated with curative intent rated their QoL higher than those treated for palliation, and early stage patients scored higher than those in the late stage. The sensitivity to clinical status of FACT-Ga scores were differential as four of seven FACT-Ga scores were significant for Treatment Intent while only one subscale score was significant for Clinical Stage. Six FACT-Ga scores had Cronbach’s α of 0.8 or above indicating excellent reliability. For construct validity, 45 of 46 items converged about their respective subscales. The monotrait-multimethod correlations between QoL constructs of FACT-Ga and EQ-5D were stronger than the multitrait-multimethod correlations as theoretically hypothesized, suggesting good convergent and discriminant validities.

Conclusions

Given the excellent reliability and good construct validity, FACT-Ga scores are able to distinguish patient groups with different clinical characteristics in the expected direction. Therefore FACT-Ga can be used as a discriminative instrument for measuring QoL of Chinese patients with GC.

Complications as indicators of quality assurance after 401 consecutive colorectal cancer resections: the importance of surgeon volume in developing colorectal cancer units in India

BACKGROUND

The low incidence of colorectal cancer in India, coupled with absence of specialized units, contribute to lack of relevant data arising from the subcontinent. We evaluated the data of the senior author to better define the requirements that would enable development of specialized units in a country where colorectal cancer burden is increasing.

METHODS

We retrospectively analyzed data of 401 consecutive colorectal resections from a prospective database of the senior author. In addition to patient demographics and types of resections, perioperative data like intraoperative blood loss, duration of surgery, complications, re-operation rates and hospital stay were recorded and analyzed.

RESULTS

The median age was 52 years (10-86 years). 279 were males and 122 were females. The average duration of surgery was 220.32 minutes (range 50-480 min). The overall complication rate was 12.2% (49/401) with a 1.2% (5/401) mortality rate. The patients having complications had an increase in their median hospital stay (from 10.5 days to 23.4 days) and the re-operation rate in them was 51%. The major complications were anastomotic leaks (2.5%) and stoma related complications (2.7%).

CONCLUSIONS

This largest ever series from India compares favorably with global standards. In a nation where colorectal cancer is on the rise, it is imperative that high volume centers develop specialized units to train future specialist colorectal surgeons. This would ensure improved quality assurance and delivery of health care even to outreach, low volume centers.

Quality of life tools for adult patients with cancer undergoing chemotherapy: a systematic review

BACKGROUND

The use of chemotherapeutic agents for treatment of cancer has expanded widely with multiple potent agents being administered at higher but more tolerable doses. The majority of these patients receive several cycles of chemotherapy over a period of months, resulting in a toxic physiologic environment that causes adverse effects. These adverse effects can lead to a significant impact on the patients' quality of life. Despite the amount of information regarding quality of life (QoL) instruments available in the literature, no systematic review has been conducted that examined QoL instrument that consists of all four subscales of physical, psychological, social and spiritual psychometric properties using a systematic approach.

REVIEW OBJECTIVES

The objective of this review was to critically analyse the literature and present the best available evidence related to QoL instruments, which can be used to assess adult patients with cancer on chemotherapy for use in clinical practice.

INCLUSION CRITERIA

This review included randomised control trials (RCTs) and observational studies without control group related to QoL instruments used for cancer chemotherapy. The types of participants for this review included all adults with cancer over the age of 18 years old whom have undergone chemotherapy.

SEARCH STRATEGY

A three-step search strategy was utilised to search for primary research articles published in English language from January 1998 to December 2009. An initial search of MEDLINE and CINAHL was undertaken followed by analysis of the text words contained in the title and abstract, and the text terms used to describe the article. A second search strategy using all the identified keywords and the index terms was used for the 20 databases. The relevant list of all identified articles were searched for additional articles.

RESULTS

A total of 3,149 references were retrieved during the initial search. Only 13 articles that had performed validation of the QoL instruments and contained the four subscales of physical, psychological, social and spiritual were included in this review. Four QoL instruments were identified. These include the City of Hope QOL - Ovarian Cancer Tool (QOL-OVCA), QOL-Breast cancer version (QOL-BC), New QOL tool India, and Quality of Life Index-Cancer version (QLI-CV).

CONCLUSION

The four QoL instruments included in this systematic review were validated comprehensively, which were feasible in clinical practice to assess patients with cancers undergoing chemotherapy. Although among the four QoL instruments, two are for specific types of cancer.

IMPLICATIONS FOR PRACTICE

The clinician needs to consider their specific population before selection of a suitable instrument, as not all of the identified instruments in this review are suitable for all types of cancer. The QOL-BC is breast cancer specific and QOL-OVCA is ovarian cancer specific. The QLI-CV instrument was used on patients with all types of cancer. However, male gender was absent or underrepresented with a high proportion of women with breast cancer recruited.

IMPLICATIONS FOR RESEARCH

Future research examining the validity of the shortened versions of QOL-BC, QOL-OVCA, and QLI-CV instruments and other QoL instruments comprising the four subscales are required. The new Indian QOL tool may be useful in the clinical setting but needs further psychometric testing in different settings or languages.

Cancer survivorship: a new challenge for surgical and medical oncologists

Increasingly, oncology practitioners are realizing that despite the "success" of cancer therapies, cancer survivors are facing previously unrecognized issues related to survivorship, including physical and psychosocial side-effects of the cancer and its treatment, second cancers, and practical and economic issues related to adjusting to life after their cancer diagnosis. In gastrointestinal cancers, traditionally, the medical and surgical oncologists charged with the care of the patient are not well-equipped to deal with these survivorship issues. At the Penn State Cancer Institute's newly formed Gastrointestinal Cancer Survivorship Clinic, we provide a full array of services to optimize care through a multi-disciplinary approach. By utilizing a multi-disciplinary model with the primary medical and surgical oncologists spearheading the survivorship initiative and psychological and pastoral support as a priority, we hope to optimize cancer survivor care and patient quality of life.

Esophagectomy for the treatment of esophageal cancer

Esophageal cancer is an aggressive disease with an overall poor prognosis. Esophagectomy remains a key therapeutic option in treating patients who have this disease. Tailoring the surgical approach to the patient and the nature of his or her malignancy is essential. Over time, advances in staging, preoperative assessment, operative techniques, and postoperative care have resulted in decreased operative mortality and better long-term outcomes.