ASO Visual Abstract: Cancer-Related Fatigue after Esophageal Cancer Surgery—Impact of Postoperative Complications

Abstract Background The impact of postoperative complications on cancer-related fatigue is unknown. This nationwide prospective cohort study aimed to assess the trajectory of cancer-related fatigue and the influence of predefined postoperative complications on cancer-related fatigue up to 2 years after esophageal cancer surgery. Methods The patients in this study underwent esophagectomy between 2013 and 2019 in Sweden. The exposure was predefined postoperative complications. The outcome was cancer-related fatigue measured by the fatigue scale of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) and the EORTC QLQ-Fatigue 12 (QLQ-FA12) questionnaire. Linear mixed-effects models provided adjusted fatigue scores and mean score differences (MDs) with 95% confidence intervals (CIs) between patients with and without predefined complications. Results The study enrolled 331 patients. The QLQ-C30 fatigue score increased with clinical relevance among patients with any complications (MD, 5.8; 95% CI, 2.6–9.0) who had a higher Clavien-Dindo classification (grades 2 to 3a: MD, 7.3; 95% CI, 3.1–11.5), a medical complication (MD, 6.9; 95% CI, 3.0–10.7), or a pulmonary complication (MD, 6.9; 95% CI, 2.1–11.6) for 1–1.5 years and remained stable until 2 years after esophagectomy. Similar patterns were found in the QLQ-FA12 fatigue and QLQ-FA12 physical and emotional subscales, but not in the cognitive subscales. Conclusions Complications in general and medical and pulmonary complications in particular might be associated with increased cancer-related fatigue after esophagectomy.

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Influence of Major Postoperative Complications on Health-Related Quality of Life Among Long-Term Survivors of Esophageal Cancer Surgery

Journal of Clinical Oncology ◽

10.1200/jco.2011.40.3568 ◽

2012 ◽

Vol 30 (14) ◽

pp. 1615-1619 ◽

Cited By ~ 101

Author(s):

Maryam Derogar ◽

Nicola Orsini ◽

Omid Sadr-Azodi ◽

Pernilla Lagergren

Keyword(s):

Quality Of Life ◽

Esophageal Cancer ◽

Postoperative Complications ◽

Cancer Surgery ◽

Health Related Quality ◽

Esophageal Cancer Surgery ◽

Related Quality ◽

Health Related

Purpose To evaluate the effect of major postoperative complications on health-related quality of life (HRQL) in 5-year survivors of esophageal cancer surgery. Patients and Methods This study was based on the Swedish Esophageal and Cardia Cancer register with almost complete nationwide coverage and data on esophageal cancer surgery collected prospectively between 2001 and 2005. Patients who were alive 5 years after surgery were eligible. HRQL was assessed longitudinally until 5 years after surgery by using the validated European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire C30 and OES18. Linear mixed models were used to assess the mean score difference (MD) with 95% CIs of each aspect of HRQL in patients with or without major postoperative complications. Adjustment was made for several potential confounders. Results Of 153 patients who survived 5 years, 141 patients (92%) answered the 5-year HRQL questionnaires. Of these individuals, 46 patients (33%) sustained a major postoperative complication. Dyspnea (MD, 15; 95% CI, 6 to 23), fatigue (MD, 13; 95% CI, 5 to 20), and eating restrictions (MD, 10; 95% CI, 2 to 17) were clinically and statistically significantly deteriorated throughout the follow-up in patients with major postoperative complications compared with patients without major complications. Although problems with choking declined to levels comparable with patients without major postoperative complications, sleep difficulties and gastroesophageal reflux progressively worsened during follow-up. Conclusion The occurrence of postoperative complications exerts a long-lasting negative effect on HRQL in patients who survive 5 years after esophagectomy for cancer.

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Physiotherapy With Telerehabilitation in Patients With Complicated Postoperative Recovery After Esophageal Cancer Surgery: Feasibility Study

Journal of Medical Internet Research ◽

10.2196/16056 ◽

2020 ◽

Vol 22 (6) ◽

pp. e16056 ◽

Cited By ~ 3

Author(s):

Maarten A van Egmond ◽

Raoul H H Engelbert ◽

Jean H G Klinkenbijl ◽

Mark I van Berge Henegouwen ◽

Marike van der Schaaf

Keyword(s):

Esophageal Cancer ◽

Postoperative Complications ◽

Functional Status ◽

Feasibility Study ◽

Comparison Group ◽

Intervention Group ◽

Cancer Surgery ◽

Secondary Outcome ◽

Historical Comparison ◽

Esophageal Cancer Surgery

Background Improvement of functional status with physiotherapy is an important goal for patients with postoperative complications and an increased length of hospital stay (LoS) after esophagectomy. Supervised physiotherapy with telerehabilitation instead of conventional face-to-face care could be an alternative to treat these patients in their home environment after hospital discharge (T0), but its feasibility has not yet been investigated in detail. Objective The aim of this study was to investigate the feasibility of a 12-week supervised postoperative physiotherapy intervention with telerehabilitation for patients with esophageal cancer who underwent esophagectomy and had postoperative complications or who had an increased LoS. The secondary objective was to investigate the preliminary effectiveness of telerehabilitation on functional recovery compared with usual care. Methods A prospective feasibility study with a matched historical comparison group was performed. Feasibility outcomes included willingness and adherence to participate, refusal rate, treatment duration, occurrence of adverse events, and patient satisfaction. Secondary outcome measures were measurements of musculoskeletal and cardiovascular functions and activities according to the domains of the International Classification of Functioning, Disability and Health. Results A total of 22 patients with esophageal cancer who underwent esophagectomy and had postoperative complications or an increased LoS were included. The mean age at surgery was 64.55 (SD 6.72) years, and 77% (17/22) of patients were male. Moreover, 15 patients completed the intervention. Patient adherence was 99.8% in the first 6 weeks and dropped to 75.6% in the following 6 weeks, with a mean difference of −24.3% (95% CI 1.3 to 47.2; P=.04). At 3 months post operation, no differences in functional status were found between the intervention group and the matched historical comparison group. Conclusions This study showed that a postoperative physiotherapeutic intervention with telerehabilitation is feasible for patients with postoperative complications or an increased LoS after esophageal cancer surgery up to 6 weeks after T0.

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Postoperative Complications and Health-related Quality of Life 10 Years After Esophageal Cancer Surgery

Annals of Surgery ◽

10.1097/sla.0000000000002972 ◽

2020 ◽

Vol 271 (2) ◽

pp. 311-316 ◽

Cited By ~ 8

Author(s):

Joonas H. Kauppila ◽

Asif Johar ◽

Pernilla Lagergren

Keyword(s):

Quality Of Life ◽

Esophageal Cancer ◽

Postoperative Complications ◽

Cancer Surgery ◽

Health Related Quality ◽

Esophageal Cancer Surgery ◽

Related Quality ◽

Health Related

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Physiotherapy With Telerehabilitation in Patients With Complicated Postoperative Recovery After Esophageal Cancer Surgery: Feasibility Study (Preprint)

10.2196/preprints.16056 ◽

2019 ◽

Author(s):

Maarten A van Egmond ◽

Raoul H H Engelbert ◽

Jean H G Klinkenbijl ◽

Mark I van Berge Henegouwen ◽

Marike van der Schaaf

Keyword(s):

Esophageal Cancer ◽

Postoperative Complications ◽

Functional Status ◽

Feasibility Study ◽

Comparison Group ◽

Intervention Group ◽

Cancer Surgery ◽

Secondary Outcome ◽

Historical Comparison ◽

Esophageal Cancer Surgery

BACKGROUND Improvement of functional status with physiotherapy is an important goal for patients with postoperative complications and an increased length of hospital stay (LoS) after esophagectomy. Supervised physiotherapy with telerehabilitation instead of conventional face-to-face care could be an alternative to treat these patients in their home environment after hospital discharge (T0), but its feasibility has not yet been investigated in detail. OBJECTIVE The aim of this study was to investigate the feasibility of a 12-week supervised postoperative physiotherapy intervention with telerehabilitation for patients with esophageal cancer who underwent esophagectomy and had postoperative complications or who had an increased LoS. The secondary objective was to investigate the preliminary effectiveness of telerehabilitation on functional recovery compared with usual care. METHODS A prospective feasibility study with a matched historical comparison group was performed. Feasibility outcomes included willingness and adherence to participate, refusal rate, treatment duration, occurrence of adverse events, and patient satisfaction. Secondary outcome measures were measurements of musculoskeletal and cardiovascular functions and activities according to the domains of the International Classification of Functioning, Disability and Health. RESULTS A total of 22 patients with esophageal cancer who underwent esophagectomy and had postoperative complications or an increased LoS were included. The mean age at surgery was 64.55 (SD 6.72) years, and 77% (17/22) of patients were male. Moreover, 15 patients completed the intervention. Patient adherence was 99.8% in the first 6 weeks and dropped to 75.6% in the following 6 weeks, with a mean difference of −24.3% (95% CI 1.3 to 47.2; <i>P</i>=.04). At 3 months post operation, no differences in functional status were found between the intervention group and the matched historical comparison group. CONCLUSIONS This study showed that a postoperative physiotherapeutic intervention with telerehabilitation is feasible for patients with postoperative complications or an increased LoS after esophageal cancer surgery up to 6 weeks after T0.

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