Pancreatic Enzyme Supplementation Improves Quality of Life in Patients Following Surgery for Upper GI Cancer

180 Background: Esophago-gastric cancers are aggressive malignancies requiring numerous investigations to plan complex multi-modal therapy. The path from initial diagnosis to treatment can be associated with a long delay. This delay and complex patient trajectory may impact quality of life. Given the poor prognosis and highly symptomatic nature of upper GI cancer, a clear and timely access to treatment of crucial importance. We sought to determine the impact of a newly implemented streamlined and structure interdisciplinary pathway for newly diagnosed esophageal and gastric cancer on access times to treatment and quality of life (QoL). Methods: A streamlined pathway for patients referred to a high volume Upper GI Cancer clinic was generated with input from physicians, nutritionists, specialized nurses, and social workers. New diagnosis of esophageal or gastric cancer from 2014-16 were enrolled in this program and consenting patients completed serial QoL questionnaires (ESAS) at baseline, pre-treatment, 1 month post treatment. Dysphagia (DS) was quantified on a 5 point scale. Time intervals (days) were evaluated at various points between diagnosis and start of treatment (diagnosis, CT imaging, first visit with upper GI program, start of treatment). Data presented as median(IQR), * p < 0.05. Results: Of the 251 patients with Upper GI cancer, 153 (61%) consented to participate including 140 esophageal/EGJ and 13 gastric cancer patients. Clinical stage distribution was 17.9% I, 30.7% II, 42.6% III, 8.7% IV. Of the 82 Esoph/EGJ patients with completed QoL questionnaires, 15 (18.3%) patients had severe dysphagia (DS = 3-4) and were prioritized for treatment. Patients with severe dysphagia had reduced time from index endoscopy to treatment (29 (16.3-39.3) vs 43 (32.8-68.0)days)* and first Upper GI clinic to treatment (15 (8.0-23.0) vs 25 (21.0-36.0)*. ESAS surveys showed increased QoL for both patients with and without dysphagia from baseline to pre-treatment indicating that simply entry into the streamlined program improved QoL. Conclusions: Structured interdisciplinary investigative and treatment programs for upper GI cancers can expedite time to treatment and improve QoL.

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The Effectiveness of Nutrition Interventions Combined with Exercise in Upper Gastrointestinal Cancers: A Systematic Review

Nutrients ◽

10.3390/nu13082842 ◽

2021 ◽

Vol 13 (8) ◽

pp. 2842

Author(s):

Fatemeh Sadeghi ◽

David Mockler ◽

Emer M. Guinan ◽

Juliette Hussey ◽

Suzanne L. Doyle

Keyword(s):

Quality Of Life ◽

Physical Functioning ◽

Muscle Wasting ◽

Cochrane Library ◽

Exercise Interventions ◽

Upper Gi ◽

Gi Cancer ◽

Upper Gi Cancer ◽

Upper Gastrointestinal

Malnutrition and muscle wasting are associated with impaired physical functioning and quality of life in oncology patients. Patients diagnosed with upper gastrointestinal (GI) cancers are considered at high risk of malnutrition and impaired function. Due to continuous improvement in upper GI cancer survival rates, there has been an increased focus on multimodal interventions aimed at minimizing the adverse effects of cancer treatments and enhancing survivors’ quality of life. The present study aimed to evaluate the effectiveness of combined nutritional and exercise interventions in improving muscle wasting, physical functioning, and quality of life in patients with upper GI cancer. A comprehensive search was conducted in MEDLINE, EMBASE, Web of Science, Cochrane Library, and CINHAL. Of the 4780 identified articles, 148 were selected for full-text review, of which 5 studies met the inclusion criteria. Whilst reviewed studies showed promising effects of multimodal interventions on physical functioning, no significant differences in postoperative complications and hospital stay were observed. Limited available evidence showed conflicting results regarding the effectiveness of these interventions on preserving muscle mass and improving health-related quality of life. Further studies examining the impact of nutrition and exercise interventions on upper GI patient outcomes are required and would benefit from reporting a core outcome set.

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P-OGC03 Pancreatic enzyme supplementation improves quality of life in patients following surgery for upper GI cancer

British Journal of Surgery ◽

10.1093/bjs/znab430.131 ◽

2021 ◽

Vol 108 (Supplement_9) ◽

Author(s):

Robert Kay ◽

Callum Alexander ◽

Sajid Waheed Rahman ◽

Chris Deans

Keyword(s):

Quality Of Life ◽

Pancreatic Enzyme ◽

Treatment Quality ◽

Exocrine Insufficiency ◽

Abdominal Symptoms ◽

Patient Reported ◽

Before And After ◽

Health Domains ◽

Enzyme Supplementation

Abstract Background Unpleasant abdominal symptoms are common following surgery for upper gastrointestinal (UGI) cancer and may occur secondary to pancreatic exocrine insufficiency (EPI). This study investigated symptoms of EPI in patients following surgery and assessed the effect of pancreatic enzyme supplementation (PERT) on these symptoms and the effect of supplementation on quality of life. Methods Patients were assessed for symptoms of EPI using a novel questionnaire. Patients who reported two or more symptoms suggestive of EPI were prescribed PERT. Abdominal symptoms were reassessed following treatment. Quality of life (QoL) was studied using the SF-36 questionnaire before and after treatment. Faecal elastase was also measured in a patient subgroup. Results Fifty-six out of 57 patients (98%) reported at least two symptoms of EPI. Following PERT every patient reported fewer abdominal symptoms; median 5 symptoms before treatment reduced to two symptoms following treatment (p < 0.0001; Wilcoxon rank). Reduced faecal elastase concentration was associated with more frequent abdominal symptoms; median 5 symptoms versus 3 symptoms (p = 0.043; Mann Whitney U test). PERT increased quality of life scores for every patient in each of the 5 principle health domains. Conclusions Symptoms of EPI are common among patients following UGI cancer surgery. PERT reduces unpleasant abdominal symptoms and this leads to significant improvements in quality of life across global health domains. PERT should be offered to all post-operative UGI cancer patients with symptoms suggestive of EPI.

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Impact of Socio-Economic Deprivation on Mortality Rates after Upper GI Cancer Surgery

Endoscopy ◽

10.1055/s-2006-956827 ◽

2006 ◽

Vol 38 (11) ◽

Author(s):

Y Leigh ◽

J Seagroatt ◽

S Cole ◽

M Goldacre ◽

P McCulloch

Keyword(s):

Mortality Rates ◽

Cancer Surgery ◽

Economic Deprivation ◽

Upper Gi ◽

Gi Cancer ◽

Upper Gi Cancer

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Quality of life in patients with upper GI malignancies managed by a strategy of chemoradiotherapy alone versus surgery

Surgical Oncology ◽

10.1016/j.suronc.2019.05.021 ◽

2019 ◽

Vol 30 ◽

pp. 33-39

Author(s):

Lauren O'Connell ◽

Mary Coleman ◽

N. Kharyntiuk ◽

Thomas N. Walsh

Keyword(s):

Quality Of Life ◽

Upper Gi

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Gastrointestinal (GI) symptoms, quality of life and endoscopic diagnoses in patients with upper GI symptoms

Gastroenterology ◽

10.1016/s0016-5085(08)81187-0 ◽

2001 ◽

Vol 120 (5) ◽

pp. A239-A240

Author(s):

Elisabeth Bolling-Sternevald ◽

Rolf Carlsson ◽

Claus Aalykke ◽

Benedicte Wilson ◽

Ola Junghard ◽

...

Keyword(s):

Quality Of Life ◽

Upper Gi ◽

Gi Symptoms

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Palliation of Upper GI Cancer

Encyclopedia of Pain ◽

10.1007/978-3-642-28753-4_101665 ◽

2013 ◽

pp. 2790-2790

Keyword(s):

Upper Gi ◽

Gi Cancer ◽

Upper Gi Cancer

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P-OGC66 Mental Health and Wellbeing Services for Patients with Upper GI Cancer

British Journal of Surgery ◽

10.1093/bjs/znab430.194 ◽

2021 ◽

Vol 108 (Supplement_9) ◽

Author(s):

Claire Coleman ◽

Wendy Hickey ◽

Cathy White

Keyword(s):

Mental Health ◽

Mental Health Services ◽

Health Services ◽

Well Being ◽

Verbal Information ◽

Patient Cohort ◽

Upper Gi ◽

Gi Cancer ◽

Number Of Patients ◽

Upper Gi Cancer

Abstract Background Cancer related distress has a major impact on quality of life. The psychosocial needs of patients post an oesophagectomy are significant and exacerbate the physical burden. The Upper GI MDT at our hospital aim to provide holistic patient centred care that equips patients mentally and physically for their treatment pathway. Formal or structured pyschoncology services are not routinely available to our patient cohort. The aim of the audit undertaken was to assess awareness of and subsequent engagement with available mental health services in patients undergoing a curative resection for oesophagogastric cancer. Methods Patients who underwent either a gastrectomy or oesophagectomy in the Upper GI Centre between Nov 2018 and May 2019 were included. They each received a questionnaire to complete anonymously. Responses were via prepaid post. Responses were collated and analysed. Results 36 questionnaires sent out with 21 patients responding (Response rate 58%). Average age:69 (age range 40-84). 18 of the 21 responses were male Time diagnosed with cancer: 57% were between 12 to 18 months post diagnosis and 43% between 6 to 11 months. Source of Information received: 43% reported verbal information provided and 38% reported written information was provided Current engagement with Mental Health Services: National, Community, and Exercise programmes were used by a very small number of patients - 6 in total out of 21 respondents Reasons for not engaging with Mental Health Services responses included ‘Not being interested or required' to ‘fearful' ‘No knowledge of service' to ‘Cant remember ' or ‘Plans to engage' 93% of respondents would recommend use of wellbeing or mental health services to someone with a diagnosis of an Upper GI Cancer Suggestions for improvements varied from use of information packs, information on life post op and more guidance needed surrounding availability of current mental health supports Conclusions Psychosocial issues need to be addressed and there is a huge deficit in current service provision. Current service is not meeting service user needs and not empowering patients how best to manage mental burden and thus contribute to maximising treatment outcomes. National Cancer Strategy acknowledges lack of access for cancer patients to pyschoncology services. The Cancer Centre is awaiting appointment of a Pyschoncology Consultant and Team in the coming months. The Upper GI MDT will seek access to this service once available for their patient cohort. In interim use limited national and community resources available. Provide education to wider team members to standardise approach providing both written and verbal information on available mental health and well being services, embed mental health awareness into daily practice with encouragement for early patient intervention if cancer related distress evident. Re Audit after introduction of these measures.

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