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Malthaner RA, Yu E, Sanatani M, Lewis D, Warner A, Dar AR, Yaremko BP, Bierer J, Palma DA, Fortin D, Inculet RI, Fréchette E, Raphael J, Gaede S, Kuruvilla S, Younus J, Vincent MD, Rodrigues GB. The quality of life in neoadjuvant versus adjuvant therapy of esophageal cancer treatment trial (QUINTETT): Randomized parallel clinical superiority trial. Thorac Cancer 2022; 13:1898-1915. [PMID: 35611396 PMCID: PMC9250846 DOI: 10.1111/1759-7714.14433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 04/03/2022] [Accepted: 04/06/2022] [Indexed: 11/29/2022] Open
Abstract
Background We compared the health‐related quality of life (HRQOL) in patients undergoing trimodality therapy for resectable stage I‐III esophageal cancer. Methods A total of 96 patients were randomized to standard neoadjuvant cisplatin and 5‐fluorouracil chemotherapy plus radiotherapy (neoadjuvant) followed by surgical resection or adjuvant cisplatin, 5‐fluorouracil, and epirubicin chemotherapy with concurrent extended volume radiotherapy (adjuvant) following surgical resection. Results There was no significant difference in the functional assessment of cancer therapy‐esophageal (FACT‐E) total scores between arms at 1 year (p = 0.759) with 36% versus 41% (neoadjuvant vs. adjuvant), respectively, showing an increase of ≥15 points compared to pre‐treatment (p = 0.638). The HRQOL was significantly inferior at 2 months in the neoadjuvant arm for FACT‐E, European Organization for Research and Treatment of Cancer quality of life questionnaire (EORTC QLQ‐OG25), and EuroQol 5‐D‐3 L in the dysphagia, reflux, pain, taste, and coughing domains (p < 0.05). Half of patients were able to complete the prescribed neoadjuvant arm chemotherapy without modification compared to only 14% in the adjuvant arm (p < 0.001). Chemotherapy related adverse events of grade ≥2 occurred significantly more frequently in the neoadjuvant arm (100% vs. 69%, p < 0.001). Surgery related adverse events of grade ≥2 were similar in both arms (72% vs. 86%, p = 0.107). There were no 30‐day mortalities and 2% vs. 10% 90‐day mortalities (p = 0.204). There were no significant differences in either overall survival (OS) (5‐year: 35% vs. 32%, p = 0.409) or disease‐free survival (DFS) (5‐year: 31% vs. 30%, p = 0.710). Conclusion Trimodality therapy is challenging for patients with resectable esophageal cancer regardless of whether it is given before or after surgery. Newer and less toxic protocols are needed.
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Affiliation(s)
- Richard A Malthaner
- Department of Oncology, Divisions of Thoracic Surgery and Surgical Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Edward Yu
- Radiation Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Michael Sanatani
- Medical Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Debra Lewis
- Department of Oncology, Divisions of Thoracic Surgery and Surgical Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Andrew Warner
- Radiation Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - A Rashid Dar
- Radiation Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Brian P Yaremko
- Radiation Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Joel Bierer
- Department of Oncology, Divisions of Thoracic Surgery and Surgical Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - David A Palma
- Radiation Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Dalilah Fortin
- Department of Oncology, Divisions of Thoracic Surgery and Surgical Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Richard I Inculet
- Department of Oncology, Divisions of Thoracic Surgery and Surgical Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Eric Fréchette
- Department of Oncology, Divisions of Thoracic Surgery and Surgical Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Jacques Raphael
- Medical Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Stewart Gaede
- Radiation Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Sara Kuruvilla
- Medical Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Jawaid Younus
- Medical Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Mark D Vincent
- Medical Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - George B Rodrigues
- Radiation Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Tang E, Bansal A, Novak M, Mucsi I. Patient-Reported Outcomes in Patients with Chronic Kidney Disease and Kidney Transplant-Part 1. Front Med (Lausanne) 2018; 4:254. [PMID: 29379784 PMCID: PMC5775264 DOI: 10.3389/fmed.2017.00254] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 12/21/2017] [Indexed: 01/31/2023] Open
Abstract
Chronic kidney disease (CKD) is a complex medical condition that is associated with several comorbidities and requires comprehensive medical management. Given the chronic nature of the condition, its frequent association with psychosocial distress, and its very significant symptom burden, the subjective patient experience is key toward understanding the true impact of CKD on the patients’ life. Patient-reported outcome measures are important tools that can be used to support patient-centered care and patient engagement during the complex management of patients with CKD. The routine collection and use of patient-reported outcomes (PROs) in clinical practice may improve quality of care and outcomes, and may provide useful data to understand the disease from both an individual and a population perspective. Many tools used to measure PROs focus on assessing health-related quality of life, which is significantly impaired among patients with CKD. Health-related quality of life, in addition to being an important outcome itself, is associated with clinical outcomes such as health care use and mortality. In Part 1 of this review, we provide an overview of PROs and implications of their use in the context of CKD. In Part 2, we will review the selection of appropriate measures and the relevant domains of interest for patients with CKD.
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Affiliation(s)
- Evan Tang
- Multi-Organ Transplant Program, Division of Nephrology, University Health Network, Toronto, ON, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - Aarushi Bansal
- Multi-Organ Transplant Program, Division of Nephrology, University Health Network, Toronto, ON, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - Marta Novak
- Centre for Mental Health, University Health Network, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Istvan Mucsi
- Multi-Organ Transplant Program, Division of Nephrology, University Health Network, Toronto, ON, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
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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: 26] [Impact Index Per Article: 3.7] [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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Inoue T, Ito S, Ando M, Nagaya M, Aso H, Mizuno Y, Hattori K, Nakajima H, Nishida Y, Niwa Y, Kodera Y, Koike M, Hasegawa Y. Changes in exercise capacity, muscle strength, and health-related quality of life in esophageal cancer patients undergoing esophagectomy. BMC Sports Sci Med Rehabil 2016; 8:34. [PMID: 27822378 PMCID: PMC5093971 DOI: 10.1186/s13102-016-0060-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 10/25/2016] [Indexed: 12/26/2022]
Abstract
Background Surgery for cancer of the thoracic esophagus is a challenging procedure associated with high morbidity and mortality. Perioperative rehabilitation has been introduced to promote early mobilization of the patients and to prevent postoperative pulmonary complications. The purpose of the present study was to characterize the preoperative functional exercise capacity, muscle strength, anxiety, depression, and health-related quality of life (QOL) in patients with esophageal cancer, and to evaluate the impact of radical esophagectomy on these parameters. Methods We performed a retrospective review of 34 consecutive patients with newly diagnosed resectable esophageal cancer who underwent esophagectomy followed by postoperative rehabilitation from January to December 2014. Patients were tested for 6-min walk distance (6MWD), knee-extensor muscle strength, hand grip strength, the Hospital Anxiety and Depression Scale (HADS), and the chronic obstructive pulmonary disease (COPD) assessment test (CAT) before and two weeks after the surgery. Before surgery, the pulmonary function test, and components of the MOS 36-item Short-Form Health Survey (SF-36) Questionnaire for general health were assessed. Results The mean age was 67.3 ± 8.1 years. The patients were predominantly male (76.4 %), had high rates of smoking history (91.2 %), and squamous cell carcinoma (97.1 %). The predicted value for forced expiratory volume in 1 s was 94.0 ± 15.9 %, and 12 patients (35.3 %) had COPD. The clinical stage was 0-I in 12 patients, II in 4 patients, III in 16 patients, and IV in 2 patients. Thirty-one patients (91.2 %) underwent open surgery. At the baseline, components of the SF-36 scores significantly correlated with CAT and HADS scores, and the physical status was significantly poorer in patients with COPD than those without. Comparisons between the preoperative and postoperative values revealed significant decreases in 6MWD, hand grip strength, isometric knee extensor muscle strength, and a significant increase in CAT scores but not in HADS scores after surgery. In multiple regression analysis, decreases in 6MWD after the surgery significantly correlated with the preoperative physical component summary of SF-36. Conclusions Our results indicate that surgery remained detrimental to health outcomes at two weeks. Further research should investigate whether prehabilitation would improve the postoperative outcomes, QOL, and physical fitness. Electronic supplementary material The online version of this article (doi:10.1186/s13102-016-0060-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Takayuki Inoue
- Department of Rehabilitation, Nagoya University School of Medicine, Nagoya, 466-8550 Japan
| | - Satoru Ito
- Department of Rehabilitation, Nagoya University School of Medicine, Nagoya, 466-8550 Japan.,Department of Respiratory Medicine, Nagoya University School of Medicine, Nagoya, 466-8550 Japan
| | - Masahiko Ando
- Center for Advanced Medicine and Clinical Research, Nagoya University School of Medicine, Nagoya, 466-8550 Japan
| | - Motoki Nagaya
- Department of Rehabilitation, Nagoya University School of Medicine, Nagoya, 466-8550 Japan
| | - Hiromichi Aso
- Department of Respiratory Medicine, Nagoya University School of Medicine, Nagoya, 466-8550 Japan
| | - Yota Mizuno
- Department of Rehabilitation, Nagoya University School of Medicine, Nagoya, 466-8550 Japan
| | - Keiko Hattori
- Department of Rehabilitation, Nagoya University School of Medicine, Nagoya, 466-8550 Japan
| | - Hiroki Nakajima
- Department of Rehabilitation, Nagoya University School of Medicine, Nagoya, 466-8550 Japan
| | - Yoshihiro Nishida
- Department of Rehabilitation, Nagoya University School of Medicine, Nagoya, 466-8550 Japan
| | - Yukiko Niwa
- Gastroenterological Surgery II, Nagoya University School of Medicine, Nagoya, 466-8550 Japan
| | - Yasuhiro Kodera
- Gastroenterological Surgery II, Nagoya University School of Medicine, Nagoya, 466-8550 Japan
| | - Masahiko Koike
- Gastroenterological Surgery II, Nagoya University School of Medicine, Nagoya, 466-8550 Japan
| | - Yoshinori Hasegawa
- Department of Respiratory Medicine, Nagoya University School of Medicine, Nagoya, 466-8550 Japan
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Chen ZY, Yang YC, Liu LM, Liu XG, Li YI, Li LP, Hu X, Zhang RY, Song Y, Qin Q. Comparison of the clinical value of multi-band mucosectomy versus endoscopic mucosal resection for the treatment of patients with early-stage esophageal cancer. Oncol Lett 2015; 9:2716-2720. [PMID: 26137134 DOI: 10.3892/ol.2015.3098] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 02/25/2015] [Indexed: 01/14/2023] Open
Abstract
The present study aimed to compare the clinical value of multi-band mucosectomy (MBM) versus endoscopic mucosal resection (EMR) for the treatment of patients with early-stage esophageal cancer. Between January 2011 and December 2012, 68 patients with early-stage esophageal cancer who underwent MBM and EMR were enrolled into the present study. The curative resection rate, duration of surgery, complications and follow-up records were retrospectively analyzed. Of the 68 patients included, 33 were treated with MBM and 35 with EMR. There was no significant difference in the rate of complete resection between the MBM and EMR groups (P>0.05). The mean duration of surgery in the MBM group was statistically lower than that in the EMR group (P<0.05). There was no statistically significant difference in the intraoperative and post-operative complications between the MBM and EMR groups (P>0.05). Esophageal cancer reoccurred in 2 patients treated with MBM and 1 patient treated with EMR during the follow-up period (range, 3-24 months). Overall, MBM can be considered a better surgical option for the management of patients with early-stage esophageal cancer, as it offers higher histological curative resection rates and improved safety. However, further studies and a larger follow-up period are required to confirm the long-term curative effect.
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Affiliation(s)
- Zi-Yang Chen
- Department of Digestion, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, Sichuan 610072, P.R. China
| | - Yun-Chao Yang
- Department of Digestion, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, Sichuan 610072, P.R. China
| | - Li-Mei Liu
- Department of Digestion, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, Sichuan 610072, P.R. China
| | - Xiao-Gang Liu
- Department of Digestion, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, Sichuan 610072, P.R. China
| | - Y I Li
- Department of Digestion, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, Sichuan 610072, P.R. China
| | - Liang-Ping Li
- Department of Digestion, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, Sichuan 610072, P.R. China
| | - Xiao Hu
- Department of Digestion, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, Sichuan 610072, P.R. China
| | - Ren-Yi Zhang
- Department of Digestion, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, Sichuan 610072, P.R. China
| | - Yan Song
- Department of Digestion, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, Sichuan 610072, P.R. China
| | - Qin Qin
- Department of Digestion, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, Sichuan 610072, P.R. China
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Pullmer R, Linden W, Rnic K, Vodermaier A. Measuring symptoms in gastrointestinal cancer: a systematic review of assessment instruments. Support Care Cancer 2014; 22:2941-55. [PMID: 24865875 DOI: 10.1007/s00520-014-2250-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Accepted: 04/09/2014] [Indexed: 01/01/2023]
Abstract
PURPOSE It is critical for gastrointestinal cancer researchers and clinicians to have access to comprehensive, sensitive and simple-to-use symptom measures that allow them to understand and quantify the subjective patient experience. Development and validation of such scales requires training in psychometrics and occasionally uses technical jargon that can be difficult to penetrate. This review evaluates existing measures of gastrointestinal cancer symptoms, provides tool descriptions, and uses predefined, objective quality criteria to rate psychometric quality and facilitate tool choices for researchers and clinicians. METHODS MEDLINE, EMBASE, CINAHL, and PsycINFO databases were systematically reviewed for scales assessing gastrointestinal cancer and gastrointestinal cancer site-specific symptoms. Evaluation criteria were the following: breadth of domain coverage (content validity), high internal consistency (α ≥ .80), sensitivity to change, and extent of validation. RESULTS In n = 36 validation studies, 26 gastrointestinal cancer symptom measures were identified. Of these, n = 13 tools met criteria for recommendation, and six in particular showed strong psychometric properties. The Functional Assessment of Cancer Therapy-Colorectal (FACT-C), European Organization for Research and Treatment of Cancer (EORTC) gastric cancer module (QLQ-STO22), FACT-Hepatobiliary (FACT-Hep), and EORTC oesophagus, oesophago-gastric junction and stomach module (QLQ OG-25) were identified as the most comprehensive and best validated scales for each of the major gastrointestinal cancer sites. The FACT-Colorectal Symptom Index (FCSI-9) and the National Comprehensive Cancer Network (NCCN) FACT-Hepatobiliary Symptom Index (FHSI-18) were specifically validated in patients with advanced colorectal and liver cancer and also demonstrated superior psychometric properties. CONCLUSIONS Several comprehensive, well-validated scales exist to adequately assess gastrointestinal cancer site-specific symptoms. Specifically, gastrointestinal cancer submodules of the FACT quality of life questionnaire represent adequate tool choices in most instances and overall, were better validated than the respective EORTC tools. Further improvement of existing, highly rated measures is recommended.
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Affiliation(s)
- Rachelle Pullmer
- Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, BC, V6T 1Z4, Canada,
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Macefield RC, Jacobs M, Korfage IJ, Nicklin J, Whistance RN, Brookes ST, Sprangers MAG, Blazeby JM. Developing core outcomes sets: methods for identifying and including patient-reported outcomes (PROs). Trials 2014; 15:49. [PMID: 24495582 PMCID: PMC3916696 DOI: 10.1186/1745-6215-15-49] [Citation(s) in RCA: 119] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 01/17/2014] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Synthesis of patient-reported outcome (PRO) data is hindered by the range of available PRO measures (PROMs) composed of multiple scales and single items with differing terminology and content. The use of core outcome sets, an agreed minimum set of outcomes to be measured and reported in all trials of a specific condition, may improve this issue but methods to select core PRO domains from the many available PROMs are lacking. This study examines existing PROMs and describes methods to identify health domains to inform the development of a core outcome set, illustrated with an example. METHODS Systematic literature searches identified validated PROMs from studies evaluating radical treatment for oesophageal cancer. PROM scale/single item names were recorded verbatim and the frequency of similar names/scales documented. PROM contents (scale components/single items) were examined for conceptual meaning by an expert clinician and methodologist and categorised into health domains. A patient advocate independently checked this categorisation. RESULTS Searches identified 21 generic and disease-specific PROMs containing 116 scales and 32 single items with 94 different verbatim names. Identical names for scales were repeatedly used (for example, 'physical function' in six different measures) and others were similar (overlapping face validity) although component items were not always comparable. Based on methodological, clinical and patient expertise, 606 individual items were categorised into 32 health domains. CONCLUSION This study outlines a methodology for identifying candidate PRO domains from existing PROMs to inform a core outcome set to use in clinical trials.
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Affiliation(s)
- Rhiannon C Macefield
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - Marc Jacobs
- Department of Medical Psychology, Academic Medical Center/University of Amsterdam, Meibergdreef 5, Amsterdam NL 1105 AZ, Netherlands
| | - Ida J Korfage
- Department of Public Health, Erasmus MC, P.O. Box 2040, Rotterdam NL 3000 CA, Netherlands
| | - Joanna Nicklin
- Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Level 3, Dolphin House, Bristol Royal Infirmary, Marlborough Street, Bristol BS2 8HW, UK
| | - Robert N Whistance
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - Sara T Brookes
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - Mirjam AG Sprangers
- Department of Medical Psychology, Academic Medical Center/University of Amsterdam, Meibergdreef 5, Amsterdam NL 1105 AZ, Netherlands
| | - Jane M Blazeby
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
- Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Level 3, Dolphin House, Bristol Royal Infirmary, Marlborough Street, Bristol BS2 8HW, UK
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Abstract
Esophageal cancer, although considered uncommon in the United States, continues to exhibit increased incidence. Esophageal cancer now ranks seventh among cancers in mortality for men in the United States. Even as treatment continues to advance, the mortality rate remains high, with a 5-year survival rate less than 35%. Esophageal cancer typically is discovered in advanced stages, which reduces the treatment options. When disease is locally advanced, esophagectomy remains the standard for treatment. Surgery remains challenging and complicated. Multiple surgical approaches are available, with the choice determined by tumor location and stage of disease. Recovery is often fraught with complications-both physical and emotional. Nursing care revolves around complex care managing multiple body systems and providing effective education and emotional support for both patients and patients' families. Even after recovery, local recurrence and distant metastases are common. Early diagnosis, surgical advancement, and improvements in postoperative care continue to improve outcomes.
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Donohoe CL, McGillycuddy E, Reynolds JV. Long-Term Health-Related Quality of Life for Disease-Free Esophageal Cancer Patients. World J Surg 2011; 35:1853-60. [DOI: 10.1007/s00268-011-1123-6] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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The safety and effectiveness of endoscopic and non-endoscopic approaches to the management of early esophageal cancer: a systematic review. Cancer Treat Rev 2010; 37:11-62. [PMID: 20570442 DOI: 10.1016/j.ctrv.2010.04.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Revised: 04/13/2010] [Accepted: 04/25/2010] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Traditionally, management of early cancer (stages 0-IIA) has comprised esophagectomy, either alone or in combination with chemotherapy and/or radiotherapy. Recent efforts to improve outcomes and minimize side-effects have focussed on minimally invasive, endoscopic treatments that remove lesions while sparing healthy tissue. This review assesses their safety and efficacy/effectiveness relative to traditional, non-endoscopic treatments for early esophageal cancer. METHODS A systematic review of peer-reviewed studies was performed using Cochrane guidelines. Bibliographic databases searched to identify relevant English language studies published in the last 3 years included: PubMed (i.e., MEDLINE and additional sources), EMBASE, CINAHL, The Cochrane Library, the UK Centre for Reviews and Dissemination (NHS EED, DARE and HTA) databases, EconLit and Web of Science. Web sites of professional associations, relevant cancer organizations, clinical practice guidelines, and clinical trials were also searched. Two independent reviewers selected, critically appraised, and extracted information from studies. RESULTS The review included 75 studies spanning 3124 patients and 10 forms of treatment. Most studies were of short term duration and non-comparative. Adverse events reported across studies of endoscopic techniques were similar and less significant compared to those in the studies of non-endoscopic techniques. Complete response rates were slightly lower for photodynamic therapy (PDT) relative to the other endoscopic techniques, possibly due to differences in patient populations across studies. No studies compared overall or cause-specific survival in patients who received endoscopic treatments vs. those who received non-endoscopic treatments. DISCUSSION Based on findings from this review, there is no single "best practice" approach to the treatment of early esophageal cancer.
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Kondra J, Ong SRY, Clifton J, Evans K, Finley RJ, Yee J. A change in clinical practice: a partially stapled cervical esophagogastric anastomosis reduces morbidity and improves functional outcome after esophagectomy for cancer. Dis Esophagus 2008; 21:422-9. [PMID: 19125796 DOI: 10.1111/j.1442-2050.2007.00792.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Cervical esophagogastric anastomoses are commonly used for reconstruction after esophagectomy because of the lower mortality rate associated with an anastomotic leak compared to intrathoracic anastomoses. However, cervical esophagogastric anastomoses have been criticized for their higher leak rates, stricture formation and greater need for later dilatations when compared with intrathoracic anastomoses. Multiple studies have looked at varying techniques to improve the outcome of the cervical esophagogastric anastomosis. This study was performed to determine whether a partially stapled (posterior stapled wall and anterior hand-sewn wall) anastomosis reliably reduced leaks and the need for later dilatation. From January 2001 to March 2006, 168 patients who underwent cervical esophagogastric anastomosis following esophagectomy (transhiatal or three-hole) for cancer were identified. Beginning in September 2003, the partially stapled technique was introduced and used in 79 patients. Clinical outcomes were compared to patients in whom hand-sewn technique was used (n = 89). Outcomes related to anastomotic leak, other hospital complications, length of stay, postoperative dilatations and survival were compared using Student's t-tests and chi-square tests (P < 0.05), as well as multiple regression analyses. An anastomotic leak occurred in 10 (12.7%) patients who received a partially stapled anastomosis. A hand-sewn anastomosis was complicated by an anastomotic leak in 24 patients (27.0%). This difference was statistically significant (P = 0.021). This lowered incidence of leak was associated with an earlier initiation of oral feeds (median 7 vs. 9.5 days, P < 0.001) and a reduction in hospital stay (median 10 vs. 15 days, P < 0.001). Furthermore, dysphagia associated with stricture requiring postoperative dilatations was markedly diminished in the stapled anastomosis [23 (31.3%) vs. 49 (55.1%), P = 0.001]. The partially stapled cervical esophagogastric anastomosis significantly decreased the incidence of postoperative anastomotic leaks and the need for postoperative dilatation to treat strictures compared to the hand-sewn anastomosis.
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Affiliation(s)
- J Kondra
- Division of Thoracic Surgery, University of British Columbia,Vancouver, British Columbia, Canada
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